Prescribed treatment is a category of treatment that has been identified as requiring special consideration before being undertaken. The Act currently defines electro- convulsive therapy and some neurosurgery as prescribed treatment. Special consent provisions apply for these procedures. Other treatments may be determined to be prescribed treatment by government regulation.
What is prescribed psychiatric treatment?
Under the Mental Health Act 2009 (SA), there are two categories of prescribed psychiatric treatment – electro convulsive therapy (ECT) and neurosurgery for mental illness.
What is prescribed medical treatment?
Prescribed treatments under the Guardianship & Administration Act 1993 (SA) are sterilisation and termination of pregnancy for people with a mental incapacity.
The provisions relating to neurosurgery are in section 43 of the Mental Health Act 2009 (SA). Neurosurgery for mental illness means leucotomy, amygdaloidotomy, hypothalamotomy, temporal lobectomy, cingulectomy, electrode implantation in the brain or any brain surgery for the relief of mental illness by elimination or stimulation of apparently normal brain tissues.
This surgery needs to be authorised by two psychiatrists (at least one being a senior psychiatrist), each of whom has separately examined the patient, in addition to the agreement of the person who is to carry out the surgery. The patient must be 16 years or over. This surgery requires the written consent of the patient or the consent of the Guardianship Board if the patient cannot give consent.
ECT (Electroconvulsive Therapy)
The provisions relating to ECT are contained in section 42 of the Mental Health Act 2009 (SA).
ECT can only be administered to a patient who has a mental illness if it has been authorised, or is part of a course of treatment that has been authorised, by a psychiatrist who has personally examined the patient. If the patient is capable of giving effective consent, the consent to the treatment must be in writing. A written consent covers a maximum period of 3 months or for a maximum of 12 treatments.
When the patient is incapable of giving consent, a legal guardian or medical agent can do so. A parent or a guardian can consent for a child who is under 16 years of age. Where consent cannot be given by the patient or on behalf of the patient by those above, an application can be made by a medical practitioner or mental health clinician to the Guardianship Board for consent.
Where treatment is urgently required for the protection of the patient or other persons, then an episode of ECT treatment can be given on the psychiatrist’s authority.
Appeals from orders for neurosurgery or ECT
A decision of the Guardianship Board to consent to neurosurgery or ECT can be appealed to District Court. Under section 67(1) of the Guardianship & Administration Act 1993 (SA), anyone who has a proper interest in the matter can appeal. This includes the person to whom the proceedings relate, the person who made the application, and any person who gave evidence at the Guardianship Board hearing.
The correct form is Form V1-1, Notice of appeal or application for leave to appeal. This form must be lodged at the District Court. Copies of the form are kept at the District Court, the Office of the Public Advocate and the Guardianship Board.
Dissatisfaction with decision of guardian, medical agent or parent regarding ECT
The following steps can be taken if the person receiving ECT treatment or another interested party is dissatisfied with the decision of a guardian, medical agent or parent to consent to or refuse ECT.
- In the case of a medical agent(s), an application can be made to the Supreme Court to have the agent(s) decision reviewed;
- In the case of a guardian of an adult, an application can be made to the Board for revocation of the appointment of an enduring guardian or guardian; and
- In the case of a parent a challenge can be lodged in the Supreme Court.
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