Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(11) 955–957 DOI: 10.1177/0004867415612583 © The Royal Australian and New Zealand College of Psychiatrists 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com Australian & New Zealand Journal of Psychiatry, 49(11) Introduction All Australian mental health acts allow a doctor to detain and treat a person with a mental illness without consent, providing certain conditions are met. However, after a period, psychiatrists may only continue compulsory treat- ment, if authorised to do so after application to a tribunal. Psychiatrists should only make such applications when they believe that continued compulsory treatment is the only practicable avenue available to pro- tect their patients from harm. In the vast majority of cases, tribunals approve such applications. However, when a tribunal refuses to uphold an application, the treating psychiatrist may form the view that this has deprived the patient of the only option for safe and effective care. The acts all provide a mechanism for patients to appeal a tribunal’s deci- sion allowing their continued deten- tion. However, no act contains provisions allowing the psychiatrist to appeal a decision and, when patients are discharged by the tribunal, there is an expectation they will be allowed to leave hospital promptly. On occasion, a question may arise as to under what circumstances a cli- nician might lawfully re-impose com- pulsory treatment after a tribunal has discharged a patient from a prior order. A recent decision of the Victorian Supreme Court – XX v WW and Middle South Area Mental Health Service (2014) VSC 564 (‘XX v WW’) – has provided at least some guidance on this matter. The facts surrounding the case, the decision and its implica- tions are set out below. The facts XX was a woman with bipolar disor- der who in 2012 had suffered serious injury after jumping from a height. In August 2013, she was admitted invol- untarily to a Melbourne psychiatric unit. Seven days after her admission, a psychiatrist made XX subject to an Involuntary Treatment Order (ITO). XX appealed against the ITO to the Victorian Mental Health Review Board (as the relevant tribunal was then termed). During the hearing, XX told the Board that upon discharge, she would return to live with a friend who lived locally. She also said that she would follow up with her regular pri- vate psychiatrist. The Board had inquired about her relationship with her friend and whether her children, who lived with her husband, would be able to visit that home. XX also indi- cated that, in the longer term, she might relocate to Queensland but that, if she did, she would first organise fol- low-up with a Queensland psychiatrist. The Board discharged the ITO as it considered one of the criteria for involuntary treatment of the, then operative, Mental Health Act 1986 (Vic) did not apply. Specifically, it found that XX could receive adequate treatment as a voluntary patient under the care of her private psychiatrist, and therefore compulsory treatment was not the manner of treatment least restrictive of her ‘freedom of decision and action’ (s 8(1)(e)). After the hearing, around lunchtime, XX returned to ward and made preparations for discharge. At some point later, she advised ward staff that, contrary to what she had said in the hearing, she intended to immediately take up residence with a former employer in Queensland. At around 3:30 p.m., WW, an intern on the unit, asked a nurse member of the Mental Health Crisis and Assessment Team to assess XX. The nurse docu- mented that XX had impulsively planned to go to Queensland with or without her children. The nurse noted that she had had no contact with her former employer for 5 years and that no formal psychiatric follow-up had been arranged. She also considered that XX was unaware of the role med- ication might play in keeping her well. At around 4:00 p.m., after receiving the nurse’s assessment and after con- sultation with XX’s inpatient psychia- trist, WW filled in the prescribed form noting the criteria for involuntary treatment applied to XX and When is it lawful to re-impose compulsory psychiatric treatment after discharge by a mental health tribunal? Mannat Mehr Kaur Malhi 1 and Christopher James Ryan 2,3 1 Wadham College, University of Oxford, Oxford, UK 2 Discipline of Psychiatry, Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, NSW, Australia 3 Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia Corresponding author: Christopher Ryan, Department of Psychiatry, Westmead Hospital, Westmead, NSW 2145, Australia. Email: christopher.ryan@sydney.edu.au 612583ANP 0 0 10.1177/0004867415612583ANZJP EditorialMalhi and Ryan research-article 2015 Editorial