Second psychiatric opinions

Seeking a second psychiatric opinion

An ‘eligible patient’ can seek a second psychiatric opinion at any time.

An eligible patient is a person who is subject to a Temporary Treatment Order or Treatment Order, a security patient or a forensic patient.

An authorised psychiatrist must ensure reasonable steps are taken to assist an eligible patient who asks for help to obtain a second psychiatric opinion. This may include assistance to decide the most appropriate psychiatrist to provide the second psychiatric opinion. This may be decided by the patient's circumstances in each case including, the purpose for which the opinion is sought, the diagnosis, the urgency of the request and the patient's financial circumstances.

Other people may also seek a second psychiatric opinion for an eligible patient:

• any person if requested to do so by an eligible patient,
• a guardian of the eligible patient
• a parent of an eligible patient under 16 years of age
• the Secretary, DFFH if the eligible patient is on a relevant child protection order

Other consumers who are not ‘eligible patients’ can also seek second opinions, but the requirements and processes described here and set out in Part 2.7 of the Act will not apply to that opinion.

Providers of second psychiatric opinions

A second psychiatric opinion can be sought from any psychiatrist. This may include:

• another psychiatrist at the patient's treating designated mental health service
• a psychiatrist from a different designated mental health service
• a private psychiatrist
• the Second Psychiatric Opinion Service.

Role of the psychiatrist giving a second psychiatric opinion

A psychiatrist giving a second psychiatric opinion under the Act reviews the treatment provided to an eligible patient and may recommend changes.

For patients on Temporary Treatment Orders or Treatment Orders and security patients (eligible patients), the second opinion psychiatrist will also provide an opinion about whether the criteria for the relevant order apply.

A psychiatrist giving a second psychiatric opinion cannot override or change the treatment being provided by the authorised psychiatrist or the person’s treating team.

The psychiatrist giving a second psychiatric opinion may:

• examine the eligible patient
• access any relevant heath information that is held by the designated mental health service treating the eligible patient
• consult the authorised psychiatrist and any other staff of the designated mental health service about the eligible patient's treatment.

In deciding whether to recommend any changes to the patient’s treatment, the second opinion psychiatrist must have regard to the patient's views and preferences about treatment, any reasonably available beneficial alternative treatment and the reasons for these views and preferences including any recovery outcomes the patient would like to achieve.

This includes the views and preferences of the patient set out in their advance statement of preferences if they have one.

To the extent reasonable in the circumstances the psychiatrist must also have regard to:

• the views of the patient’s nominated support person (if any)
• the views of the patient’s guardian (if any)
• the views of a carer if the psychiatrist is satisfied the recommended changes will directly affect the carer and the care relationship
• the views of a parent, if the patient is under 16 years
• the views of the Secretary to the Department of Families, Fairness and Housing if the patient is under a relevant child protection order

Staff of a designated mental health service must provide a psychiatrist giving a second psychiatric opinion any reasonable assistance that the psychiatrist requires in order to perform or exercise their functions or powers.

For more information on these terms, see Terms and definitions.

Second psychiatric opinion reports

The psychiatrist giving a second psychiatric opinion must prepare a written report and must ensure that reasonable steps are taken to give that report, in a timely manner to:

• the patient
• the person who requested the second psychiatric opinion on behalf of the patient (if relevant)
• the authorised psychiatrist
• the patient’s nominated support person (if applicable)
• the patient’s guardian (if applicable)
• the patient’s carer where the second opinion will directly affect the carer and the care relationship
• the patient’s parent, if the patient is under 16 years
• the Secretary of the Department of Families, Fairness and Housing if the patient is under a relevant child protection order.

Role of the authorised psychiatrist who receives a second psychiatric opinion report

An authorised psychiatrist must consider any second psychiatric opinion report and may make changes to the patient’s treatment based on the recommendations.

If the second psychiatric opinion expresses an opinion that the criteria for the relevant order do not apply to a patient

If a second psychiatric opinion report expresses an opinion that the criteria for the relevant order do not apply to a patient on a Temporary Treatment Order or a Treatment Order or a security patient, the authorised psychiatrist must:

• examine the patient as soon as practicable; and
• determine whether the criteria for the relevant order apply.

If the authorised psychiatrist determines that the criteria for the order do not apply, they must immediately revoke the order.

If the authorised psychiatrist determines the criteria for the order do apply, then they must provide the patient with reasons for that determination as soon as practicable and advise the patient that they have a right to apply to the Mental Health Tribunal for a determination as to whether the criteria do apply or for revocation of the order.

The reasons for the determination must be provided in writing within 10 business days to:

• the patient
• the person who requested the second psychiatric opinion on behalf of the patient (if relevant)
• the patient’s nominated support person (if applicable)
• the patient’s guardian (if applicable)
• the patient’s carer where the second opinion will directly affect the carer and the care relationship
• the patient’s parent, if the patient is under 16 years
• the Secretary of the Department of Families, Fairness and Housing if the patient is under a relevant child protection order.

If the second opinion psychiatrist’s report recommends changes to the eligible patient's treatment

If a second psychiatric opinion report recommends changes to an eligible patient’s current treatment, the authorised psychiatrist must as soon as practicable:

• review the patient’s treatment; and
• decide whether to adopt any of the recommendations.

If the authorised psychiatrist decides not to adopt any of the recommendations or to adopt only some of the recommendations in the report the authorised psychiatrist must

• give their reasons to the eligible patient for adopting none or only some of the recommendations and provide an explanation of the reasons; and
• advise the eligible patient that they have a right to apply to the Chief Psychiatrist for a review of their treatment.

The reasons for the determination must be provided in writing within 10 business days to:

• the patient
• the person who requested the second psychiatric opinion on behalf of the patient (if relevant)
• the patient’s nominated support person (if applicable)
• the patient’s guardian (if applicable)
• the patient’s carer where the decision will directly affect the carer and the care relationship
• the patient’s parent, if the patient is under 16 years
• the Secretary of the Department of Families, Fairness and Housing if the patient is under a relevant child protection order.

An eligible patient (or any of the people listed above who can apply for a second psychiatric opinion) may apply to the Chief Psychiatrist for a review of the patient’s treatment if the authorised psychiatrist does not adopt any or all of the recommendations in a second psychiatric opinion report.

Staff of a designated mental health service must provide an eligible patient with any reasonable assistance in making an application to the Chief Psychiatrist for a review of their treatment.

The Chief Psychiatrist may recommend changes to the treatment and can direct an authorised psychiatrist to make changes to the eligible patient’s treatment.

More information about the process for Chief Psychiatrist review is available from the Office of the Chief Psychiatrist.