Chief Psychiatrist's annual report 2008-09 - Department of Health

Chief Psychiatrist’s annual report 2008–09 37
8 Forensic mental health
Forensic mental health services are provided to mentally ill offenders or to those consumers who
present a serious risk of offending behaviour. Courts can make specified orders when determining
the most appropriate disposition for a person where mental illness has played a role in the
offending behaviour. Instead of a sentence, or by way of a sentence, a court may direct a person to
receive treatment as an involuntary patient in an approved mental health service.
In Victoria, forensic mental health services are provided through the Victorian Institute of Forensic
Mental Health (Forensicare) and are located within the prison system, in a specialist forensic
mental health hospital (Thomas Embling Hospital) and the community-based forensic mental health
service in Clifton Hill. The Chief Psychiatrist is a member of the external advisory group providing
support to a large research program carried out under the auspices of Forensicare.
The Chief Psychiatrist has a range of responsibilities for mentally ill offenders under the Mental Health
Act and the Crimes (Mental Impairment and Unfitness to be Tried) Act.
8.1 Restricted involuntary treatment orders, hospital orders
and restricted community treatment orders
The Sentencing and Mental Health Acts (Amendment) Act made significant changes to the
provisions governing hospital orders, hospital security orders and restricted community treatment
orders, effective from 1 October 2006. Essentially the amendments replaced hospital orders with
a new order known as a restricted involuntary treatment order (RITO), which can only be made
for a maximum of two years for people found guilty of a non-serious offence. Special transition
arrangements were made for those patients on existing hospital orders at 1 October 2006, as these
orders were deemed to expire on 1 October 2008.
When the court makes a person subject to a RITO, the person must be taken to and detained in a
mental health service as an inpatient. When the person’s condition has improved to the extent that
they can be treated and managed safely in the community, the authorised psychiatrist may make a
restricted community treatment order (RCTO) enabling the person to continue their treatment in the
community. The authorised psychiatrist must notify the Chief Psychiatrist of the making of an RCTO 19 .
In 2008–09, 10 RITOs and 12 RCTOs were made under the new provisions (compared to 19 RITOs
and 21 RCTOs in 2007–08).
8.2 Security patients
Security patients are those detained in an approved mental health service for treatment of
their mental illness, either on a court order under the Sentencing Act (s.93(1)(e)) as part of their
sentence, or by order of the Secretary of the Department of Justice under the Mental Health Act
(s.16). In Victoria, such patients receive treatment and care for their mental illness in Thomas
Embling Hospital (a secure specialist forensic mental health facility) until it is appropriate for them
to be returned to prison or to the community if they have reached the end of their sentence.
19 For further information see program management circulars: Sentencing and Mental Health Acts (Amendment)
Act 2005: Summary of key amendments, Changes to hospital orders under the Sentencing Act 1991 and Restricted
involuntary treatment orders and restricted community treatment orders.