Mental health staff need a risk rating system and script when telling emergency services a patient has absconded from a mental health facility, a review has recommended.
A review into the circumstances surrounding an alleged stabbing at the Australian National University in September has recommended a series of improvements into leave management from mental health facilities.
The ACT government has announced a taskforce will consider the 35 recommendations made by former ACT psychiatrist Dinesh Arya who led the review.
Alex Leonard Ophel, 24, was a patient at the Gawanggal Mental Health Unit when he allegedly stabbed two women and attacked two others at the ANU on September 18. Ophel was on approved leave. He has been charged with two counts of attempted murder and common assault.
Dr Arya's report does not include an overview of the circumstances or decisions related to Ophel's care. The case is currently before the courts and health authorities are prevented from releasing information under the Health Records Act.
The report was into "care, treatment and support provided to people deemed not guilty because of mental impairment".
The report recommends legislation changes to better support agencies involved in support people found not guilty due to mental impairment, greater powers for the ACT Civil and Administrative Tribunal and to have more mental health experts involved in decision-making.
Mental Health Minister Emma Davidson said the report was vital to ensure the rights of people found not guilty due to mental impairment were balanced with concerns for the safety of themselves and the community.
"Leave from a mental health facility serves an important function for people in their treatment, care, support, rehabilitation and return to the community," she said.
"It strengthens their support networks and strategies to keep them mentally healthier when they are back in the community."
The government's taskforce overseeing the recommendations will include representatives from health agencies, the Justice and Community Safety Directorate and ACAT.
"We will consult with stakeholders on how to best implement these recommendations and ensure that our justice system meets the needs and safety of both individuals and the broader community," Attorney-General Shane Rattenbury said.
Better communication
Among the recommendations were that Canberra Health Services should design a template to help staff talk to police and ambulance when someone has failed to return from leave, or absconded.
Police told the review panel there was "no consistency in the information provided in these reports to police".
"Often the police do not get the information they need to assess the risk to the person or the community," the report said.
"Having information on people ... would better enable them to report to reports [someone had] absconded or not returned from leave.
"Without the information on the level of risk the person presents or appropriate details about the person, [there is a limit on] their ability to respond."
Concerns have previously been raised about a call to police to report Ophel was missing. A mental health nurse was told to call a police assistance line after she first tried to report Ophel missing.
ACT police were first notified of an incident at the university at 2.45pm after a Triple Zero call.
A nurse from Gawanggal called the emergency line at 2.55pm, telling police they had a non-returned patient. Police said it was not an emergency, and the nurse was told to call the assistance police line.
At 3.02pm, the nurse spoke to someone on that line for 19 minutes. At 3.13pm, ACT police called health services for information on Ophel.
Consider community safety before granting leave
While leave from a mental health facility helps someone re-integrate into the community, the safety of the public needed to be considered, the report said.
"Several protections including a gradual leave program need to be built into the process of granting leave," it said.
The report recommended there needed to be explicit opportunities for leave decisions to be appealed at every decision point.
Currently, a leave panel meets weekly to discuss patient requests.
While there are several members of the panel, the two most senior have authority to overrule the others.
Before someone goes on leave, staff assess their mental state.
A panel deciding whether someone should be granted leave from a mental health facility should be chaired by someone with forensic mental health experience, the report said.
They should be separate to the treatment team or staff in the facility in which the person in question lives.
There should also be a member who can represent community safety concerns.
The leave panel must report to ACAT when considering changing a person's leave provisions.
Consider mental disorders, likelihood of offending
The report repeatedly said tribunals and panels considering decisions about people who are found not guilty because of mental impairment needed to consider any mental disorders and a person's likelihood to commit a crime.
"The reason why a person who is deemed not guilty because of mental impairment is often required to reside at the most secure mental health facility in the territory is because the person is considered to have an underlying psychopathology that ... may present risks to the person, others and the general community," it said.
Restrictions placed on a person who is found not guilty because of mental impairment must consider mental disorders, compliance, and their insight into their mental illness, Dr Anya recommended.
The tribunal should also notify a person representing the interests of the community when making decisions about someone under section 180, Dr Arya suggested.
Some such as the Victims of Crime Commission or Director of Public Prosecution should be allowed to give evidence at a hearing.
This person representing community safety should be given necessary information by police and corrective services.
More mental health experts in decision-making
The report also recommended ACAT should have someone who is a forensic mental health professional when considering the detention of a person under the Mental Health Act.
It said in making decisions about a person detained because of their mental health, ACAT should be required to consider a comprehensive forensic psychiatric or psychological report.
"Any advice provided to ACAT must be informed by a comprehensive forensic mental health assessment," Dr Anya advised.
That should include a risk assessment and a longitudinal history of the person.
- Support is available for those who may be distressed. Phone Lifeline 13 11 14; Kids Helpline 1800 551 800; beyondblue 1300 224 636; 1800-RESPECT 1800 737 732.
