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 neurosurgery for mental illness 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 and Administration Act 1993 (SA) are sterilisation and termination of pregnancy for people with a mental incapacity.

Neurosurgery

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 the person who is to carry it out, two psychiatrists (at least one being a senior psychiatrist), each of whom has separately examined the patient, and the Prescribed Psychiatric Treatment Panel. The patient must be 16 years or over. This surgery requires the written consent of the patient or, if consent cannot be given by the patient, the consent of SACAT must be obtained by an application to the Tribunal..

A written report from the person who has conducted the neurosurgery is required to be given to the Chief Psychiatrist within 3 months of the neurosurgery [s 43(2a)].

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. The patient must be 16 years or over. 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 [s 42(2)]. Consent once given may be withdrawn at any time by the person who has given it [s 42(4)(c)].

When the patient is incapable of giving consent, a substitute decision-maker under an advance care directive or a medical agent or guardian of the patient 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 SACAT for consent [s 42((5)]. Consent to ECT treatment extends to the administration of anaesthetics required for the purpose of the ECT treatment but does not extend to the use of force [s 42(4)(b)]. However, restraint or force may be used where an order has been made by SACAT for the treatment, but only insofar as it is reasonably required in the circumstances [s 34A].

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, however, notification must be made to the Chief Psychiatrist within one business day [s 42(7)].

Appeals from orders for neurosurgery or ECT

A decision of SACAT to consent to neurosurgery or ECT can be reviewed on application for an internal review [s 83A].

Dissatisfaction with decision of a substitute decision maker 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 substitute decision maker or parent to consent to or refuse ECT.