Memorandum of understanding for the delivery of services to people with mental illness

The following information (Version Two) was first published May 2020. 

Foreword

The Tasmanian Health Service, Ambulance Tasmania and Tasmania Police are often required to provide services to people affected by mental illness.

This includes - but is not limited to - people with a known or suspected mental illness who are escorted or transported to or from an approved facility or between approved facilities under the Mental Health Act 2013, Criminal Justice (Mental Impairment) Act 1999 or other legislation.

A shared understanding about the roles, responsibilities and priorities of the Tasmanian Health Service, Ambulance Tasmania and Tasmania Police in responding to situations involving people with mental illness is critical for ensuring the best consumer and community outcomes and the most efficient and effective use of resources.

This Memorandum represents a strong commitment by all parties to work together to ensure safe outcomes for consumers, their families and support people, police officers, paramedics and health workers, as well as for the broader Tasmanian community.

I am pleased to present this Second Version of Tasmania’s Memorandum of Understanding for the Delivery of Services to People with Mental Illness.

Dr Aaron Robert Groves
Chief Civil Psychiatrist | Chief Forensic Psychiatrist
Office of the Chief Psychiatrist

August 2020

Purpose and Scope

The purpose of this information is to:

• Clarify the roles and responsibilities of the parties when responding to situations involving people with mental illness generally.
• Clarify the roles and responsibilities of the parties in the provision of transport and escort services under the Mental Health Act 2013, Criminal Justice (Mental Impairment) Act 1999 and related legislation.
• Foster a collaborative and cooperative approach between the parties.
• Provide a framework for the development of region-specific working protocols.

The information represents a formal written statement of intent between the parties. It is not legally binding and does not override the requirements of relevant laws, regulations, guidelines or protocols.

The terms “consumers”, “individual with a mental illness” and “person with mental illness” are used to refer both to people with a diagnosed mental illness and to people who are reasonably believed to have a mental illness.

“Mental illness” and other key terms are defined at Appendix 1.

Principles

General principles

Underpinning this agreement is the recognition by all parties that:

1. People with mental illness have the same rights as people with any other health condition. This includes rights to liberty, dignity, autonomy and self-respect.
2.  Any interference with or restriction on the rights of persons with mental illness should occur in the least restrictive way, and to the least extent consistent with the need to protect the person, the need to protect the public, and with the efficient, effective and appropriate delivery of services.
3. Collaboration and cooperation between the Tasmanian Health Service, Ambulance Tasmania and Tasmania Police is critical for ensuring safe and positive outcomes for people with mental illness and for the community.
4.  The primary role of the Tasmanian Health Service is to provide hospital, primary and community health services.
5. The primary role of Ambulance Tasmania is to provide emergency paramedic care, medical retrieval services, non-emergency patient transport services and aero-medical services.
6. The primary role of Tasmania Police is to provide policing and emergency management services.
7. In performing functions, each of the parties is required to have regard to their primary role or roles and to comply with relevant laws, regulations, guidelines and protocols.

Protective custody, transport and escort principles

In relation to protective custody and the transport and escort of people with a mental illness, all parties agree that:

1. Protective custody, transport and escort of people with mental illness should occur in the least restrictive way consistent with the need to protect the person and the public, with the efficient, effective and appropriate delivery of services and with due regard for available resources.
2.  Whenever possible, consumers, their representatives and their support people should be involved in decisions about custody, transport and escort.
3.  Protective custody, transport and escort should involve cooperative and coordinated action between the parties.
4. Wherever practicable, protective custody, transport and escort of people with mental illness is to involve non-police custodians, escorts and assistants.
5. Custody, transport and escort of people with mental illness by or involving police is the most restrictive means of transport and is to be utilised only in situations involving violence or significant risk of violence. Where transport and escort by the Tasmanian Health Service and/or Ambulance Tasmania is inconsistent with ensuring safe outcomes or where there is no other practical option for ensuring the person’s custody, transport or escort in a timely manner.
6. Pre-identified and non-emergency transport and escort needs associated with arrangements made by one party which require assistance from another party, will be communicated and negotiated at an early point in time to minimise disruption to the delivery of core services by the relevant party.
7. Reasonable costs levied by Tasmania Police for the escort and transportation of patients at the request of the Tasmanian Health Service will be met by the party requesting assistance.
8. In all cases, transport and escort of people with mental illness by each of the parties will be prioritised in accordance with clinical need, competing priorities and available resources and in accordance with the Mental Health Act 2013, Criminal Justice (Mental Impairment) Act 1999 and other relevant legislation.

Information principles

In relation to the collection, storage, use and disclosure of information about and concerning people with mental illness, all parties:

1. Note the Personal Information Protection Principles set out in Schedule 1 to the Personal Information Protection Act 2004 and agree to collect, use, disclose and otherwise manage information about people with mental illness in accordance with those Principles.
2. Agree to seek and disclose confidential information about and concerning people with mental illness, including crisis management/intervention plans, through the usual processes applying to information exchange whenever this is consistent with ensuring safe and positive outcomes for individuals with mental illness and the community. Wherever possible, this will be with the consumer’s informed consent.
3. Agree to disclose confidential information which may be needed to prevent or lessen a serious threat to an individual’s life, health, safety or welfare, or a serious threat to public health or safety in situations involving people with mental illness requiring response from more than one party on request, or when the disclosing party otherwise considers this to be reasonably necessary for the safe management of the situation.
4. Acknowledge that in a crisis or emergency situation, confidential information disclosed between the parties will be limited to information that is necessary to assist in the prevention or safe resolution of the situation, and may include:
   • any information that may be relevant to any attending party undertaking an appropriate risk assessment; and
   • a history of aggression or self-injury; and
   • a history of substance (alcohol or other drug) abuse; and
   • information about the possession of weapons; and
   • information about the presence of any behaviours or symptoms which may suggest a risk to police or people in authority; and
   • any failure by the patient to take prescribed medication which may initiate or exacerbate a crisis situation.
5. Agree to consult with each other and the Chief Civil Psychiatrist or Chief Forensic Psychiatrist as relevant before publishing any information about a person with a mental illness who is being assessed or treated under the Mental Health Act 2013.

Education and training principles

Each of the parties recognise the importance of cooperating in the delivery of education and training around the Mental Health Act 2013 as a means of facilitating collaborative and consistent approaches to dealing with situations involving people with mental illness.

The Tasmanian Health Service

The Tasmanian Health Service will provide staff members with:

• Education and training on relevant aspects of the Mental Health Act 2013.
• Training in the Connecting with People (CwP) approach*.
• Information about ambulance and police service delivery models and key points of contact.
• Information about the nature and level of education and training that has been provided to staff of Ambulance Tasmania and Tasmania Police in how to manage situations involving people with mental illness.

The Tasmanian Health Service will provide information and expertise to Ambulance Tasmania and Tasmania Police on a mutual basis to assist the parties to deliver education and training in accordance with these principles.

Ambulance Tasmania

Ambulance Tasmania will provide ambulance officers and other staff members with:

• Education and training on relevant aspects of the Mental Health Act 2013.
• Training in the Connecting with People approach.
• Information about health and police service delivery models and key points of contact.
• Information about the nature and level of education and training that has been provided to staff of the Tasmanian Health Service and Tasmania Police in how to manage situations involving people with mental illness.

Ambulance Tasmania will provide information and expertise to the Tasmanian Health Service and Tasmania Police on a mutual basis to assist the parties to deliver education and training in accordance with these principles.

Tasmania Police

Tasmania Police will provide police officers and other staff members with:

• Education and training on relevant aspects of the Mental Health Act 2013.
• Training in the Connecting with People approach.
• Information about health and ambulance service delivery models and key points of contact.
• Information about the nature and level of education and training that has been provided to staff of the Tasmanian Health Service and Ambulance Tasmania in how to manage situations involving people with mental illness.

Tasmania Police will provide information and expertise to the Tasmanian Health Service and Ambulance Tasmania on a mutual basis to assist the parties to deliver education and training in accordance with these principles.

Management of Situations Involving People with Mental Illness Generally

Situations involving people with mental illness should be managed using recognised de-escalation techniques in the first instance and prior to more invasive strategies being employed. See Appendix 2 for a summary of de-escalation techniques that should be utilised.

This section of the memorandum outlines the steps that each party will take when managing situations involving people with mental illness generally. The following section (Section 4) outlines the steps that each party will take in the management of situations involving people in protective custody or under escort specifically.

The Tasmanian Health Service

The Tasmanian Health Service acknowledges that it has a role in managing situations involving people with mental illness and agrees to:

1. Accept responsibility for the management of situations involving people presenting with mental illness unless, due to violence or significant risk of violence or because the ambulance service has determined the person needs paramedic care, this is inconsistent with ensuring safe outcomes.
2. Provide advice and assistance to Ambulance Tasmania and Tasmania Police in managing situations involving people with mental illness whenever possible.
3. Seek police attendance at an inpatient, residential or community facility where there is an allegation of physical violence or serious threats by patients, consumers, staff or visitors.
4.  In crisis situations involving a person with mental illness, refer requests from Ambulance Tasmania and Tasmania Police for advice and referral to the Mental Health Services Helpline on 1800 332 388 in the first instance.
5.  In emergency situations, contact Tasmania Police on 000, or if non-urgent, Radio Dispatch Services on 13 14 44, advise the operator that urgent or non-urgent police assistance is required, and:
   • explain what the problem is and the degree of urgency; and
   • provide details on the nature and location of the assistance required; and
   • advise whether weapons are present or suspected; and
   • advise who is present (for example, children, carers, Tasmanian Health Service staff or paramedics); and
   • advise if the person appears to be affected by drugs or alcohol; and
   • provide all details possible concerning the person, including the person’s name, date of birth and any other information that would enable police to, more accurately, determine the nature of the crisis; and
   • advise of any cultural aspects, or language and communication needs.
6. In emergency situations, contact Ambulance Tasmania on 000, or if non-urgent, the State Communications Centre on 1800 008 008 for advice or assistance in situations involving a person with mental illness who is believed to require paramedic care.

Ambulance Tasmania

Ambulance Tasmania acknowledges that it has a role in managing situations involving people with mental illness and agrees to:

1. Accept responsibility for the management of situations involving people with mental illness who require paramedic care or non-emergency patient transport due to requiring stretcher transport due to other conditions unless, due to violence or significant risk of violence, this is inconsistent with ensuring safe outcomes.
2. Contact the Mental Health Services Helpline on 1800 332 388 for advice and referral whenever there are concerns about the mental health of a person with whom paramedics have had contact, particularly in circumstances where recurring ambulance contact is likely to occur without appropriate intervention, wherever practicable.
3. In emergency situations, contact Tasmania Police on 000 or if non-urgent Radio Dispatch Services on 13 14 44, advise the operator that urgent or non-urgent police assistance is required, and:
   • explain what the problem is and the degree of urgency; and
   • provide details on the nature and location of the assistance required; and
   • advise whether weapons are present or suspected; and
   • advise who is present (for example, children, carers, Tasmanian Health Service staff or paramedics); and
   • advise if the person appears to be affected by alcohol or other drugs; and
   • provide all details possible concerning the person, particularly name, date of birth and any other useful information that would enable police to, more accurately, determine the nature of the crisis; and
   • advise of any cultural aspects, or language and communication needs.

Tasmania Police

Tasmania Police acknowledges that it has a role in managing situations involving people with mental illness and agrees to:

1. Assist the Tasmanian Health Service and Ambulance Tasmania to manage situations involving people with mental illness which involve violence or significant risk of violence and which cannot be safely contained by either the Tasmanian Health Service or Ambulance Tasmania.
2. Contact the Mental Health Services Helpline on 1800 332 388 for advice and referral whenever there are concerns about the mental health of a person with whom police officers have had contact, particularly in circumstances where recurring police contact is likely to occur without appropriate intervention, wherever practicable.
3. Attend an inpatient, residential or community facility to assist with responding to an allegation of physical violence or serious threats by patients, consumers, staff or visitors.
4. Contact the Mental Health Services Helpline on 1800 332 388 for advice in crisis situations involving a person with mental illness.
5. In emergency situations, contact Ambulance Tasmania on 000, or if non-urgent, the State Communications Centre on 1800 008 008 for advice or assistance in situations involving a person with mental illness who is believed to require paramedic care.

Management of Situations Involving People in Protective Custody or Under Escort

The Mental Health Act 2013 provides for the involuntary assessment and treatment of persons with serious mental illness. The legislation enables a person to be taken into protective custody by a Mental Health Officer (including an ambulance officer who is a Mental Health Officer) or police officer and enables a person on an Assessment Order or Treatment Order to be taken under escort and transported to, or from, or between, approved facilities.

A list of approved facilities is at Appendix 3.

The Mental Health Act 2013 imposes particular obligations on Mental Health Officers and police officers, and these vary depending on the part of the Act that is being utilised. In all cases, however, the Custody and Escort Provisions apply and must be complied with. These are set out at Appendix 4.

This section of the memorandum outlines the steps that each party will take in managing people with mental illness who are taken into protective custody under the Mental Health Act 2013 or who are being escorted or transported under the Mental Health Act 2013, Criminal Justice (Mental Impairment) Act 1999 or related legislation.

The Tasmanian Health Service

The Tasmanian Health Service will:

1. Take responsibility for taking a person into protective custody or under escort and for keeping a person in protective custody or under escort when the use of protective custody or the decision to take the person under escort has been initiated by the Tasmanian Health Service.
2. Only seek ambulance assistance to take a person into protective custody or under escort and for keeping a person in protective custody if paramedic care is considered to be needed or where a risk assessment has precluded the person being transported by the Tasmanian Health Service.
3. Only seek police assistance to take a person into protective custody or under escort or to keep a person in protective custody in situations involving violence or significant risk of violence which cannot be safely contained by the Tasmanian Health Service.
4. Only request assistance from Tasmania Police in conducting an ordinary search, frisk search or other type of search in respect of a person who is in protective custody or under escort, or who is being taken into protective custody or under escort, where there are concerns about concealed weapons or the impact on the security and safety of the person or others if the search is undertaken without such assistance.
5. Consider a person who has been brought to an approved assessment centre in protective custody by ambulance to have arrived as soon as the person enters the doors of the centre, or when the ambulance arrives at the designated entrance to the centre and stops, whichever occurs first.
6. Consider a person who has been brought to an approved assessment centre in protective custody by police to have arrived as soon as the person enters the doors of the centre, or when the police vehicle arrives at the designated entrance to the centre and stops, whichever occurs first.
7. Work collaboratively with Ambulance Tasmania and Tasmania Police when an ambulance officer or police officer asks to hand over a person’s protective custody.
8. Provide police officers and paramedics with a clear rationale for any decision to refuse to accept a request for protective custody to be handed over.
9. Ensure that people brought to an approved assessment centre in protective custody are given high priority and are examined at the earliest opportunity to ensure the early release of ambulance or police resources, and to minimise any disturbance or threat to patients and others at the place of assessment.
10. Where paramedics or police officers retain protective custody of the person, provide advice to those officers as to the estimated wait time.
11. Ensure that people who are brought to an approved assessment centre in protective custody are assessed by a medical practitioner as soon as practicable and in all cases, within four hours of arrival at the centre.
12. If the Tasmanian Health Service considers it necessary to lessen or prevent a serious threat to a person’s life, health, safety or welfare or a serious threat to public health or public safety, advise Tasmania Police immediately via Radio Dispatch Services on 13 14 44 if a person who has been presented for assessment by police officers is deemed not to require admission or follow-up procedures.
13. If the Tasmanian Health Service considers it necessary to lessen or prevent a serious threat to a person’s life, health, safety or welfare or a serious threat to public health or public safety, advise Ambulance Tasmania immediately via the State Communications Centre on 1800 008 008 if a person who has been presented for assessment by ambulance officers is deemed not to require admission or follow-up procedures.

Ambulance Tasmania

Ambulance Tasmania will:

1. Take responsibility for taking a person into protective custody or under escort and for keeping a person in protective custody or under escort when the use of protective custody or the decision to take the person under escort has been initiated by Ambulance Tasmania.
2. Take responsibility for a person’s custody, escort or transport where the person requires paramedic care or where a risk assessment has identified that transport by the Tasmanian Health Service would be inappropriate.
3. In all other situations, seek assistance from the Tasmanian Health Service in taking a person into protective custody or under escort and in keeping a person in custody or under escort.
4. Only seek assistance from Tasmania Police to take a person into protective custody or under escort or to keep a person in protective custody in situations involving violence or significant risk of violence which cannot be safely contained.
5. Only request assistance from Tasmania Police in conducting an ordinary search, frisk search or other type of search in respect of a person who is in protective custody or under escort, or who is being taken into protective custody or under escort, where there are concerns about concealed weapons or the impact on the security and safety of the person or others if the search is undertaken without such assistance.

Tasmania Police

Tasmania Police will:

1. Provide assistance to the Tasmanian Health Service and Ambulance Tasmania in conducting an ordinary search, frisk search or other type of search of a person who is in protective custody or under escort or who is being taken into protective custody or under escort, where there are concerns about the impact on the security and safety of the person or others if the search is undertaken without such assistance, on request.
2. Take a person into protective custody or under escort and retain custody of the person if:
   • the situation involves violence or significant risk of violence which cannot safely be managed by the Tasmanian Health Service or by Ambulance Tasmania; or
   • the patient has made credible threats to harm others or has a history of violence or aggression when in similar situations.
3. Remain involved and take appropriate action where a person in protective custody is engaged in criminal activity.
4. Where a person has been presented for assessment by police and found not to require admission, provide transport for the person, where practicable and if there is no other reasonable option, to a more appropriate place should such transport be required.

Liaison and Dispute Resolution

In relation to ongoing liaison and dispute resolution associated with the management of situations involving people with mental illness, each of the parties:

1. Agrees, in the event of a crisis situation, to establish and maintain close liaison between each of the parties at a suitably senior level. It is recommended that this liaison occur between members not below the rank of Inspector within Tasmania Police, not below the rank of Duty Manager within Ambulance Tasmania, and not below the level of Head of Department within the relevant Mental Health Service or the Medical Officer in Charge of the Emergency Department of the particular hospital in the first instance. Matters which cannot be resolved at this level should be escalated to the Medical Director, Mental Health and Statewide Services and Clinical Executive Director – Statewide Mental Health Services, and to the Head of Department of the relevant Emergency Department.
2. Agrees to participate in a Statewide Committee with responsibility for providing high level oversight of this MoU and progressing matters that are of importance Statewide or that have Statewide implications, and/or that are not capable of resolution at the regional level. Membership of the Committee will consist of senior representatives from the Tasmanian Health Service, Tasmania Police and Ambulance Tasmania, the Chief Civil Psychiatrist and Chief Forensic Psychiatrist and other relevant stakeholders (see section 6). The Statewide Committee will meet on an annual basis with additional meetings to be scheduled as may be required.
3. Agrees to participate in any Regional Committees that are established to discuss issues arising at a regional level relating to this MoU and its practical application, and to develop, if necessary, region-specific working protocols. Membership of any Regional Committees that are established will consist of District Commanders and/or nominated representatives and Regional Mental Health Liaison Officers within Tasmania Police; the Heads of Department from Mental Health Services and the Directors of Emergency Departments in each of the Regions; and Regional Managers and/or nominated representatives from within Ambulance Tasmania. Any Regional Committees that are established will meet on a quarterly basis.
4. Agrees to refer matters of policy or which may affect the delivery of services to people with mental illness to the relevant Statewide or Regional Committee representative.

Statewide Committee – Membership (Key Points of Contact)

Ambulance Tasmania

• Director, Medical Services, Ambulance Tasmania

Tasmania Police

• Mental Health Liaison Officer - Executive Support and Secretariat, Tasmania Police
• Inspector Hobart Division - Southern District, Tasmania Police
• Inspector Burnie Division - Western District, Tasmania Police
• Inspector Launceston Division - Northern District, Tasmania Police

Other

• Chief Civil Psychiatrist and Chief Forensic Psychiatrist - Office of the Chief Psychiatrist, Mental Health, Alcohol and Drug Directorate Department of Health

Period of Operation and Review

The MoU is intended to remain in place for a period of five years and will expire five years after endorsement unless each of the parties agrees otherwise in writing.

Any substantial changes to the MoU will be effected in writing via a new version. Any new version that results will be effective on the signature of each of the parties.

The agreement may be terminated by any of the parties through notice in writing to each of the other parties.