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1.0 – WHAT IS A RELEVANT DISABILITY?

DEFINING A RELEVANT DISABILITY

For the purposes of this online resource, The Advocacy and Support Centre uses the term ‘disability’ to refer to those persons the law may consider either mentally ill or intellectually impaired under the Mental Health Act 2000 (Qld) (the Act).

Although there are various competing ways of defining disability, the Act provides the statutory definition most relevant for the purposes of legal practitioners. Section 12, defines mental illness as a “condition characterised by a clinically significant disturbance of thought, mood, perception or memory”. Within this definition the word clinically denotes that the diagnosis of mental illness is one that is primarily the responsibility of an authorised psychiatrist, and made according to internationally accepted standards. It is the role of a forensic psychiatrist to make a professional diagnosis and to provide an opinion in relation to the link that may have existed, if any, between the disability and the alleged offence.

From the outset, it is important that lawyers be aware that the existence of an intellectual disability, in and of itself, does not constitute a mental illness according to section 12(2)(h). However, the existence of an intellectual disability or an acquired brain injury (ABI) is relevant for the purposes of establishing fitness for trial and the possibility of a defence of unsoundness of mind or diminished responsibility.

ABI is a complex and individual disability. The brain can be damaged as a result of an accident, a stroke, alcohol or drug abuse, tumours, poisoning, infection and disease, near drowning, hemorrhage, AIDS, and a number of other disorders such as Parkinson’s disease, Multiple Sclerosis, and Alzheimer’s disease.

The terms ABI , head injury, and acquired brain damage, describe the types of brain damage which occur after birth. Lawyers should avoid confusing an ABI with an intellectual disability. Although those with a brain injury may have difficulty controlling, coordinating and communicating their thoughts and actions, they usually retain their intellectual abilities.1

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM) is the most commonly used diagnostic tool by psychiatrists in Australia and Queensland. As a note of caution, the Manual’s introduction asserts that in forensic contexts there is potential for the misuse of its diagnostic information, and, that additional information may be required in order to establish legal standards such as criminal responsibility. Therefore, the information herein provides a very basic overview of the general nature of these disorders merely for the lay practitioner’s educative purposes.

Some common disabilities relevant to the functions of lawyers in a forensic context include, but are not limited to:

  • Schizophrenia;
  • Bipolar Affective Disorder (formerly manic depression);
  • Clinical Depression;
  • Intellectual Disability;
  • Acquired Brain Injury (ABI); and
  • Personality Disorders.

Click here for further information

Key facts about intellectual disability

Intellectual disability is a lifelong disability.

The range of disability varies greatly, spanning from a mild intellectual disability requiring low support, through to a more profound disability requiring a high level of support on a daily basis.
Intellectual disability can result from many different conditions including Down syndrome, autism and epilepsy.

1 Reference: Brain Injury Association of Qld

LATEST NEWS & INFORMATION HERE

1.1 – Mental Health Act 2000 Information Mental Health Act 2000(QLD)

The purpose of the Act is to provide for the involuntary assessment, detention and treatment of persons with a mental illness while balancing those person’s rights and freedoms with the rights and freedoms of other persons.

Under section 5, the Act purports to achieve this purpose by:e

  • Providing for the detention, examination, admission, assessment and treatment of persons having, or believed to have, a mental illness;
  • Establishing the Mental Health Review Tribunal to carry out reviews relating to involuntary patients and to hear applications to administer or perform particular treatments;
  • Establishing the Mental Health Court to decide (among other things) the state of mind of persons charged with criminal offences.

Click here to view the Mental Health Act 2000
Purpose, Principles and definitions

Chapter 1 of the Mental Health Act 2000 (the Act) sets out the Act’s purpose and the principles that guide its application. It also defines key terms used in the Act, including ‘mental illness’.

Fact Sheet 1

Chapter 1 of the Mental Health Act 2000 (the Act) sets out the Act’s purposes and the principles that guide its application.  It also defines key terms used in the Act, including ‘mental illness’.

Fact Sheet 2

The Mental Health Act 2000 (the Act) sets out processes for a person to be assessed and authorises the person’s detention for assessment.  Treatment for mental illness cannot be given unless an involuntary treatment order is made.  Information about involuntary treatment is provided in Fact sheet 3.

Fact Sheet 3

The Mental Health Act 2000 (the Act) makes provision for a person to be treated without consent under an involuntary treatment order.  The involuntary treatment order must be preceded by involuntary assessment.  Information about involuntary assessment is provided in Fact sheet 2.

Fact Sheet 4

The Mental Health Act 2000 (the Act) enables a person’s admission to an authorised mental health service from court or custody as a classified patient.

Fact Sheet 5

The Mental Health Act 2000 (the Act) provides processes to ensure matters of criminal responsibility and fitness for trial are examined when an involuntary patient is charged with an offence.  The Act also provides processes for decisions to be made about legal proceedings against the person; in particular, whether proceedings are continued or discontinued.  These processes are set out in Chapter 7 of the Act.

Fact Sheet 6

The Mental Health Review Tribunal (the Tribunal) provides an important safeguard in protecting the rights of involuntary patients under the Mental Health Act 2000 (the Act).

Chapter 12 of the Act establishes the Tribunal, provides ofr its administration and outlines procedural requirements.  The matters reviewed by the Tribunal, including powers on a review, are provided in Chapter 6 of the Act.

Fact Sheet 7

The Mental Health Act 2000 (the Act) contains provisions for patient rights by:

a.  providing safeguards for the use of involuntary provisions.

b.  involving patients in decisions affecting them.

c.  ensuring regular independent reviews of a patient’s involuntary treatment.

Fact Sheet 8

The Mental Health Act 2000 (the Act) contains provisions for assisting victims of offences by people who have a mental illness.  It also contains provisions which aim to ensure the safety of victims and the community.

Fact Sheet 9

Chapter 7A of the Mental Health Act 2000 establishes processes relating to:

a.  Classified patient information orders (CPIO) and

b.  Forensic patient information orders (FPIO)

1.2 – Information about Specific Mental Illnesses

Dual Diagnosis of Intellectual Disability and Mental Illness

Disability Services Queensland and Queensland Health have developed and implemented a collaborative approach to improving service delivery to people with a dual diagnosis of intellectual disability and mental illness.

The guidelines for collaboration between Queensland Health, Mental Health Services, Disability Services Queensland and funded Disability Services Providers, were formally introduced throughout Queensland in 2003-04.

The guidelines provide a broad framework for the provision of services to people with an intellectual disability and mental illness using a cooperative, collaborative approach that focuses on the needs of the person with a dual diagnosis.

The guidelines identify points in service provision where collaborative approaches are required. They identify some principles, processes and actions for developing agreed service delivery protocols between agencies at a local level.

Adherence to the guidelines is mandatory for Disability Services Queensland provided services. All other disability service providers are encouraged to utilise the guidelines in supporting people with a dual diagnosis as means to:

  • improve the stability and continuity of support arrangements;
  • increase access to individualised, timely, planned and coordinated services and supports;
  • increase specialist skills in supporting people with a dual diagnosis;
  • reduce the need for crisis driven responses;

Reference:


Click here for more dual diagnosis information
Click here for application for support

The facts: what is psychosis?

There is a group of illnesses which disrupt the functioning of the brain so much, they cause a condition called psychosis. When someone experiences psychosis they are unable to distinguish what is real – there is a loss of contact with reality. Most people are able to recover from an episode of psychosis.

Among symptoms doctors look for are:

  • Confused thinking – when acutely ill, people with psychotic symptoms experience disordered thinking. The everyday thoughts that let us live our daily lives become confused and don’t join up properly.
  • Delusions – delusion is a false belief held by a person which is not held by others of the same cultural background.
  • Hallucinations – the person sees, hears, feels, smells or tastes something that is not actually there. The hallucination is often of disembodied voices which no one else can hear.

Click here for more information on psychosis.

The facts: What is depression?

The word ‘depression’ is often used to describe the feelings of sadness which all of us experience at some stage of our lives. It is also a term used to describe a form of mental illness called clinical depression.

Because depression is so common, it is important to understand the difference between unhappiness or sadness in daily life and the symptoms of clinical depression.

More information on depression can be found at the following websites:

  • Beyondblue – the national depression initiative; a national, independent, not for profit organisation working to address issues associated with depression, anxiety and related substance misuse disorders in Australia.
  • DepressioNet – DepressioNet provides a comprehensive online resource providing information, help and support for Australians living with depression and their families and friends.
  • MoodGym – training program delivering cognitive behavioural therapy for preventing depression.
  • BluePages provides information about depression for consumers.
  • Queensland Health – facts on depression

The facts: what is schizophrenia?

Schizophrenia is a major mental illness affecting the normal functioning of the brain. It is characterised by psychotic symptoms and a diminished range of expressions of emotion. It affects one person in every hundred.

First onset is usually in adolescence or early adulthood. It can develop in older people, but this is not nearly as common. Some people may experience only one or more brief episodes in their lives. For others, it may remain a recurrent or life-long condition.

More information on schizophrenia can be found at the following websites:

  • The Mental Illness Fellowship of Australia – Formerly the Schizophrenia Fellowships Council of Australia this site represents people affected by severe mental illness
  • SANE Australia – a national charity helping people affected by mental illness through education, applied research and campaigning for improved services and attitudes.

1.3 – Intellectual Disability

Intellectual Disability

Intellectual disability is a developmental disorder. People with intellectual disability have significantly more difficulty than others in understanding concepts, solving problems, concentrating, remembering and learning new things. Consequently, they require extra support to learn and achieve their full potential for independence.

People with intellectual disability are people first. They have the same rights and responsibilities as other members of the community and if given the opportunity have similar dreams, hopes, aspirations, needs and interests as people without disability.

The international definition for intellectual disability has three criteria:

  • Significant limitations in intelligence—that is an intelligence quotient (IQ) of about 70 or less as measured on a standardised intellectual assessment.
  • Significant limitations in the skills needed to live and work in the community including difficulties with communication, self-care, social skills, safety and self-direction.
  • Limitations in intelligence and living skills that are evident before the person is 18 years old.

All three criteria must be present for a person to be considered as having intellectual disability.

A formal assessment by a psychologist or other appropriately qualified professional is generally required to diagnose intellectual disability. This assessment usually involves an intellectual assessment (IQ test).

In order to access Disability Services Queensland services for people with intellectual disability, a formal assessment of the person’s living skills will also be required. This is usually assessed by asking a parent, teacher or someone else who knows the referred person well to fill out a questionnaire or participate in an interview.  A psychological assessment may not be necessary if the person has been diagnosed with a syndrome that in most cases results in intellectual disability (eg Down syndrome or William syndrome).

For some people, intellectual disability occurs alongside other disabilities eg sensory impairment, physical impairment and/or medical conditions. Some people may have dual disability, that is, intellectual disability and mental illness.

These other disabilities and conditions are not a result of intellectual disability nor are they caused by intellectual disability. They are added issues to be considered when supporting a person with intellectual disability.

Reference

For further information see below

Disability Services Queensland

Issues for the Advocate in relation to’ capacity’

If there is any doubt as to the client’s “capacity” and issues around soundness of mind and fitness for trial, then a determination of the clients “capacity” needs to be determined.

A funding application made to Legal Aid Queensland (working in conjunction with lawyer) for a psychiatric report is required and must be accompanied by a GP records, school records and any other medical or health report that is available to substantiate the fact of the intellectual disability.

1.4 – Acquired Brain Injury

Acquired Brain Injury

The terms acquired brain injury (ABI), head injury, or acquired brain damage (ABD) are used to describe all types of brain damage which occur after birth.

Acquired brain injury is not to be confused with intellectual disability. People with a brain injury may have difficulty controlling, coordinating and communicating their thoughts and actions but they usually retain their intellectual abilities.

Brain injury has dramatically varied effects and no two people can expect the same outcome or resulting difficulties. The brain controls every part of our being: physically, intellectually and emotionally. When the brain is damaged, some other part of ourselves will also be adversely affected. Even a mild injury can result in a serious disability that will interfere with a person’s daily functioning and personal activities for the rest of their life. While the outcome of the injury depends largely on the nature and severity of the injury itself, appropriate treatment will play a vital role in determining the level of recovery.

Traumatic Brain Injury

Traumatic brain injury (TBI) is an acquired brain injury caused by a blow to the head or by the head being forced to move rapidly forward or backward, usually with some loss of consciousness. This may be the result of a motor vehicle accident, fall, assault, sporting accident, gunshot wound or violent shaking. As a result of this blow or rapid movement, the brain may be torn, stretched, penetrated, bruised or become swollen. Oxygen may not be able to get through to brain cells and there may be bleeding.

The impact on the individual

There is very little understanding or knowledge in the community about brain injury and the impact it has on individuals. Long term effects are difficult to predict and will be different for each person. However generally many people will experience increased fatigue, difficulty with short-term memory and impaired concentration and retention skills.
There are five areas in which people with ABI may experience long term changes:

  • Medical difficulties
  • Changes in physical and sensory abilities
  • Changes in the ability to think and learn (cognition
  • Changes in behaviour and personality (psychological)
  • Communication difficulties.

The extent of some of these changes, such as being more impulsive or getting lost easily, may only become apparent as time progresses.

Reference: Brain Injury Australia

1.5 – Qld Disability Standards

Queensland Disability Service Standards

2.0 – What is Advocacy

Definitions of Disability Advocacy

There are many definitions of advocacy and much debate exists regarding which one is the most appropriate to use. Having a definition of advocacy is necessary so that we have something to refer to, to check against and to encourage discussion about what we are doing. Action for Advocacy Development uses the following definition, which is based on the work of Dr Wolf Wolfensberger. Advocacy groups in Australia discussed this definition during a National Advocacy Workshop in Sydney in June 1994. Most of these elements were agreed to.

Advocacy is speaking, acting and writing with minimal conflict of interest on behalf of the sincerely perceived interests of a disadvantaged person or group to promote, protect and defend their welfare and justice by:

  • being on their side and no-one else’s,
  • being primarily concerned with their fundamental needs,
  • remaining loyal and accountable to them in a way which is emphatic and vigorous and which is, or could be, costly to the advocate or advocacy group.

Functioning by speaking out, acting or writing.

Advocacy is active. It involves doing something. It may be writing letters to politicians, raising issues of concern to organisations or services, being with a person when they are confronted with situations they find difficult, being with a person when they could be taken advantage of or fighting for a person’s right to live a more fulfilling life.

Minimal conflict of interest.

This issue lies at the core of advocacy and is one of the hardest, most important issues to come to grips with. In any situation there will be more than one person’s or group’s interests that will be in conflict or competition with the interest of a person with a disability. When you are in an advocacy role, you need to be clear as to how your interests and needs may be in conflict with the person for whom you are advocating. As an advocate you must identify and attempt to minimise these conflicts of interest or, at least, be prepared to acknowledge your limitations as an advocate.

Sincerely perceived interests.

This issue is one of the most complex and difficult issues for advocates to address. The advocate does not just speak up for what a person may want or what a person may be interested in. Advocates will be faced with making decisions about the life and well-being of a person with a disability and may be the only one in that person’s life who has a positive vision for that person’s future in the long term. Advocates are sometimes faced with a difficult dilemma when a client’s expressed wishes are, in the opinion of the advocate, counterprodcutive, or not in the best interest of the client and in some cases, may place the client at risk.

Promotion of person’s welfare, well being and justice.

As an advocate you do this precisely because the well being of, and justice for, disadvantaged, devalued people is often at risk. Things we take for granted are often not available for people with disabilities. Devalued people are not to be treated as sub-human with all the degrading, inhumane treatment that accompanies such notions of devalued people and people with disability in particular.

Vigour of action

Advocacy requires the advocate to:

  • demonstrate fervour and depth of feeling in advancing the cause or interest of another,
  • take the lead, and to initiate,
  • demonstrate a sense of urgency,
  • do more than what is done routinely,
  • challenge the community.

There are a number of types of advocacy, however for the purpose of this project, individual advocacy only is addressed.

“I don’t see advocacy as speaking for other people – it’s actually to encourage other people to speak for themselves. How we do it, is through empowering them, to support them. If they don’t speak the right language or have the confidence to express themselves, you be their voice but try to speak their words”. Mike Clear – Promises Promises 2000

Some definitions of advocacy found on the Web are:

  • Active support of an idea or cause etc.; especially the act of pleading or arguing for something
    wordnet.princeton.edu/perl/webwn
  • Advocacy is the act of arguing on behalf of a particular issue, idea or personAskOxford.com (Oxford dictionaries) .
    en.wikipedia.org/wiki/Advocacy
  • The profession of an advocate; the act of arguing in favour of, or supporting something; the practice of supporting someone to make their voice heard (see wikipedia:independent advocacy)
    en.wiktionary.org/wiki/advocacy
  • To encourage or support an activity that helps a consumer, company, or organization to secure health care coverage designed to best meet their unique needs.
  • is the act or process of defending or maintaining a cause or proposal. An organization may have advocacy as its mission (or part of its mission) to increase public awareness of a particular issue or set of issues.
  • Is an umbrella term for organized activism or lobbying related to a particular set of issues, in the case of FAS, gender equality.
  • Active support of a cause.
  • Taking an active role in the education and care of an individual or the act or process of supporting a cause or person.
    www.sparkle.usu.edu/glossary/index.asp
  • A process wherein the nurse, knowledgeable of the socio-political context, acts on behalf of the patient or the nursing profession to assure the delivery of quality nursing care and to promote professional standards of practice. …
  • Pushing forth a cause or creating a defence to protect the beliefs of self or others.
  • The act of speaking or of disseminating information intended to influence individual behaviour or opinion, corporate conduct or public policy and law…
  • This term refers to the role parents or guardians play in developing and monitoring their child’s educational program…
  • This is when a solicitor or barrister acts on your behalf during court / tribunal proceedings.
    www.theclaimsconnection.co.uk/personal-injury-glossary.html
  • Clear expression of support for the rights of persons with disabilities and their families.
  • Advocacy involves representing an organization through articulating the mission and supporting and defending the organization’s message. Advocacy also relates to representing and defending the rights of individuals with disabilities.
    http://www.siegelagency.com/glossary/
  • Representing the cause or interest of another, even if that cause or interest does not necessarily coincide with one’s own beliefs, opinions, conclusions, or recommendations.
  • To act on behalf of another person, to be their advocate.

3.0 – What is the Role of a Legal Practitioner in criminal law matters?

The legal profession and other Court personel play a crucial role within the criminal justice system particulary for people with a mental illness,acquired brain injury (ABI) and or intellectual disability.

One of the lawyer’s roles in the effective representation of a disabled defendant is to ensure that the defendant’s disability is properly assessed and fitness for trial and unsoundness of mind issues are properly examined.

In the event that these issues are not examined, the defendant can be exposed to significant injustice.  The role of the lawyer in excavating these issues is not too onerous given that in the far majority of cases there will be a medical history confirming the person’s disability and possibly it’s impact upon the person’s behavior.  The Disability Advocate and/or Health Professional can significantly assist the lawyer in this exploratory process by bringing to the attention of the lawyer, relevant medical documents.  Of course, it is not always the case that the person themselves will be in a position to accurately disclose their condition or where information pertaining to their condition can be found.  Thus, it is fundamentally important for both the lawyer, disability advocate and/or health professional to consult with the person’s wider support framework, including the most obvious, friends and family.  In the absence of such a framework, the person’s general practitioner is a good place to start, as too are hospital medical records obtained via the Freedom of Information Act.  Whilst the latter approach can be lengthy, it is worth accentuating the urgency of the matter to the relevant hospital department.  This may result in a waiver of the usual period.

Upon receipt of information that supports a relevant disability, in particular, information that attests to the impact of the disability on the person’s behaviour, preferably the behaviour that is now before the court, further psychiatric evidence will more than likely be required.  The psychiatric report will need to deal specifically with a number of matters, but essentially those which relate to unfitness for trial and unsoundness of mind.

Accordingly, in most cases funding for such report will need to be sought via Legal Aid Queensland.

4.0 – What is the Role of the Disability Advocate in criminal law matters

Advocacy has played a key role in assisting lawyers representing clients with a relevent disability for the past 3 years  in the first dedicated disability law project  in Queensland, The TASC Disability Law Project (DLP) .

The DLP commenced three years ago in Toowoomba. This project has focused on representing defendants with a psychiatric illness, an intellectual disability and/or Acquired Bain Injury (ABI) who have been charged with criminal offences.  The project not only provides legal representation for these defendants in the criminal courts, but also strong disability advocacy support.

One of the major factors identified throughout the life of the Disability Law Project has been the significant benefit gained by the client through the early intervention of an advocate in addressing the clients ‘life’ situation holistically, by identifying gaps in the client’s social infrastructure along with those environmental influences which may have impacted negatively on the client’s behavior. These factors when coupled with the nature of the client’s disability can often contribute significantly to the client’s offending behaviour. It has been the experience of DLP, that if these issues are resolved, recidivism is significantly minimised.

The disability advocate’s role is to investigate, assess and prioritise the issues facing the individual client. Following this assessment, the advocate may need to make appropriate applications for support, and  make referrals and linkages to community organisations. This information may be of significant importance to the lawyer involved in the matter.  Thus, it is always preferable that the disability advocate work in unison with the lawyer in order to provide the client with holistic responses.

The initial referral to the advocate may be initiated by the duty lawyer, court volunteer staff, court mental health liaison officers, friends, family and/or carers. The advocate’s involvement may commence at any time throughout the hearing of the matter from the pre investigation stage of the matter, to the of sentencing.

The role of the advocate is clearly non legal, however it forms a key role in providing the legal representative with a range of interventions including but not restricted to;

  • Medical intervention to address urgent issues such as risk to self or others
  • GP referrals for Mental Health counselling under the medicare system
  • Homelessness
  • Risk of homelessness
  • Community Housing and Community Housing and Emergency Hostels
  • Accommodation issues such as lack of bond, debt with Department of Housing, supported accommodation, suitable accommodation and support.
  • Investigation into the status of Disability Services Queensland (DSQ) Support package (check if support package in place, is it sufficient, does it ned updating, has a  registration of need been completed
  • Linkages and referrals to the appropriate community organisations funded to provide assistance with community and social access (this is not part of a DSQ package)
  • Centrelink issues such as mobility allowance applications, rent assistance applications, emergency loans and other
  • Assessment of current Education and training needs – make appropriate referrals through centrelink social workers and education liaison officers and specialised supported employment agencies and linking to state and federal training programs as appropriate.
  • Referral to Youth Services if appropriate
  • Children and complex and challenging behaviours. Referral to DSQ and the Disability Interagency Service Team (DIST); and
  • Referral to ATODS (Drug and alcohol rehabilitation programs attached to local public hospitals
  • Queensland Local Government Directory
  • Central resource directory for community services
  • Other

Attachments

5.1 – Identification of Advocacy Issues

It is necessary to understand that a person with an intellectual disability, psychiatric illness or Acquired Brain Injury may be sensitive to acknowledging their disability and in many instances will deny any disability. Questioning techniques need to be sensitive to this and the following may be of assistance in eliciting information with minimum imapct on the client.

Sample Questions:

  • Are you working or on a pension?
  • If on a pension, what type?
  • If a Disability Support Pension, what is the diagnosis?
  • Have you ever had a Case Manager?
  • What type of accommodation – private, shared, family, supported, hostel, emergency?
  • Is your rent up to date?
  • Are you receiving rent assistance?
  • Have you applied for Dept of Housing accommodation?
  • Do you have/know how to obtain bond money?
  • Are you at risk of homelessness (behind in rent, notice to quit-other issues relating to)?
  • Do you receive support from a friend, family member or carer?
  • Do you need assistance/support to access community and social access?
  • Do you need help with daily living (meals, in home help, transport, meals on wheels, budgeting, shopping)?
  • Who is your doctor?
  • If none, would you like a referral to a GP?
  • Would you like a referral for special assistance to find a job or part-time work?
  • Have you or person assisting applied for DSQ support package?
  • If yes and no success, refer for updated application required
  • If no we can refer to intake officer of DSQ

Spectrum of Vulnerability Download Attachment

Advocacy Management Plan Download Attachment

Attachments

5.2 – Intake and Case Management Plan

The items attached are part of the intake process, prioritisation process and case management. This is based on a conflict of interest check.

Attachments

5.3 – Disability Advocacy Information Kit

To view the Disability Advocacy Information Kit and Report to Lawyer

Download Attachment

Attachments

6.0 – Mental Health Act Interventions

It is essential that disability advocates understand the significance of whether or not a defendant is already the subject of an Involuntary Treatment Order or Forensic Order at the time of taking instructions from a client. For example, if a defendant is subject to the former order, Chapter 7 Part 2 of the Mental Health Act applies.

In framing an advocacy response, advice should be sought from the Department of Health’s Court Liaison Service. A Court Liaison Officer can advise as to whether the defendant is currently on an Involuntary Treatment Order (ITO) or Forensic Order (FO) under the Act and can seek further information relating to the treatment regime that is in place. The Court Liaison Office is located at the following Courts:

  • Brisbane;
  • Ipswich;
  • Toowoomba;
  • Southport;
  • Maroochydore;
  • Beenleigh; and
  • Caboolture

Advocacy Considerations

As the primary concern of the Court and law enforcers is to protect the individual and the community, the Court at times is left with no alternative but to refuse bail and remand the defendant in custody.  In supporting the lawyer, the role of the Advocate involves packaging a framework of support, safe accommodation, medical interventions and professional assistanceand ongoing monitoring by relevant agencies and/or community organisations.

Attachments

7.0 – Template authorities

Index

Page 2 Download Attachment

Attachments

8.0 – Pro formas

Index

 

Attachments

9.0 – Case Scenarios

9.1 A practical example of significant advocacy assistance

  • Client diagnosed with Schizophrenia
  • Client not on ITO

9.1 – A practical example of significant advocacy assistance

Terry is a male aged 29 years diagnosed with paranoid schizophrenia and an Acquired Brain Injury (ABI). He has a mental health history of acute psychotic episodes leading to behaviours that have resulted in a criminal history. Terry has been charged with a number of indictable offences and is before the Court again. The duty lawyer was concerned about his presentation at interview as Terry was exhibiting signs of paranoia and psychotic symptoms. An assessment with Terry’s consent was organised at the Acute Mental Health Unit (AMHU) at the local public hospital.

The outcome of the assessment was that Terry was not “unwell” or psychotic and Terry was not placed on Involuntary Treatment Order (ITO). Therefore the matter could NOT be referred under Chapter 7, part 2 of the Mental Health Act (QLD) 2000.

The lawyer remained concerned however about Terry’s mental health and applied for Legal Aid funding for an independent psychiatric report for Terry. The application gave detailed information about Terry’s mental health history and funding was later approved. A referral to a private psychiatrist was organised and a detailed letter of instruction provided, along with other medical background information and the QP9’s detailing the charges.

The private psychiatrist was of the opinion that Terry was of “unsound mind” at the time of the offending due to his disabilities.  On the basis of the psychiatric report, the matter was referred to the Mental Health Court for determination.

Advocacy Intervention

Terry’s accommodation was not suitable. A Department of Housing application was organised, as well as a Community Housing application. The advocate provided additional information regarding Terry’s circumstances to the Department for assessment as a priority application. Interim crisis accommodation organised through St Vincent’s De Paul until either Community Housing or Department Housing accommodation became available

A Registration of Need and an application for funding to provide support to Terry was organised with Disability Services Qld (DSQ). Interim Emergency and Crisis funding was provided by DSQ as Terry was at risk of going to jail if offending behaviours continued.

Assessment by DSQ professional staff organised and a behavioural management plan developed for Terry.

Referral to Acute Mental Health Unit organised and case management successfully advocated for on basis private psychiatric report.

Community and social access organised by the Advocate through the local non government agencies block funded for these type of programs. Eg Ozcare, Spiritus

A referral organised through Terry’s GP to GP Connections for ongoing regular counselling by Psychologist.

Centrelink social worker contacted and referral for Terry to specialised employment agency organised to assist Terry in seeking work.

11.0 – Glossary of Terms

To view Glossary of Mental Health words Download Attachment

ADHD Attention deficit hyperactivity disorder usually manifests in childhood or adolescence, and tends to linger through adulthood. Behaviours include difficulty maintaining attention, hypersensitivity to stimuli, incessant talking, impulsivity, incessant movement, ignoring or tuning out, anxiety, frustration and irritability.
Adynamia A lack of motivation after trauma to the frontal lobes. Characterised by difficulty initiating activities or completing tasks. Gives the appearance of lethargy.
Affect Your experience of an emotion, and the behaviour that arises from it.
Agnosia A disorder of recognition from injury to higher order information processing cells which can result in an inability to recognise or distinguish faces or objects.
Agraphia Inability to write that can arise from trauma to areas of brain responsible for cognitive or motor skills necessary to write.
Akinesia Inability to move (“freezing”) due to problems selecting and activating muscle programs in the brain.
Alculia A disorder characterised by an inability to comprehend or write numbers or perform arithmetic operations.
Alexia Inability to read due to brain damage causing cognitive or visual problems.
Alzheimer’s Disease Degenerative disorder of the brain with cognitive decline due to appearance of senile plaques followed by development of neurofibrillary tangles in the dying cells of the brain.
Amnesia Complete or partial loss of memory. Traumatic Brain Injury can cause retrograde amnesia (loss of recall of events right before the trauma) and/or anterograde amnesia (loss of recall of events for some period of time after the trauma).
Anhedonia An inability to experience pleasure from normally pleasurable life events such as eating, exercise and social or sexual interaction.
Anomia The inability to find words. Literally, “without naming ability”.
Anoneiria Inability to dream due to trauma of the areas of the brain responsible for creating dreams, which may include the medio-basal forebrain, inferior parietal cortex, medial temporal lobe or occipito-temporal cortex.
Anosmia Loss of the sense of smell by either mechanical damage to the olfactory nerve or damage to areas in the anterior temporal or oribito-frontal lobes that process the sense of smell.
Anoxia No oxygen in cells of the body. If prolonged, will cause cell death. Can be due to no oxygen reaching the blood, e.g. through strangulation or suffocation, or can be due to no blood reaching the cells, e.g. through the heart stopping or blood flow being stopped in one area by an embolism.
Aphasia Difficulty understanding or expressing language as a result of damage to the brain.
Apraxia Inability to voluntarily perform skilled and purposeful movements, but not accompanied by a loss of sensory function or paralysis.
Arterial Line A thin tube (catheter) inserted into an artery to allow direct measurement of the blood pressure, amounts of oxygen and carbon dioxide in the blood.
Ataxia Abnormal movements due to the loss of coordination of the muscles.
Autism Developmental disorder of the brain that may lead to lack of social response, inability to cope with change, ritualised behaviours.
Blood Clot A solidified localised collection of blood.
Bradykinesia The slowing down and loss of voluntary movement and speech. Is often a feature of Parkinson’s disease and diseases of the basal ganglia.
Brain Stem The lower extension of the brain where it extends to the spinal cord. Neurological functions located in the brain stem include those necessary for survival (breathing, heart rate) and for arousal (being awake and alert).
Burr Hole A 10-20mm surgical drill hole made through the skull.
CAT Scan Computerised Axial Tomography, also known as Computerised Tomography or CT Scan. A scanning technique that uses a rotating X-ray machine to record slices of your body.
Catheter A tube which is inserted into any body part to withdraw or introduce fluids.
Cerebellum The portion of the brain (located at the back) which helps coordinate movement. Damage may result in ataxia.
Cerebral Of or relating to the brain.
Cerebral Angiogram X-ray picture of the blood vessels inside the head. A drug is injected via the groin artery which outlines these cerebral vessels.
Cerebral Cortex The outer layer of the brain, responsible for cognitive processes including reasoning, mood, perception of stimuli and other thought processes.
Cerebro-Spinal Fluid Liquid which fills the ventricles of the brain and surrounds the brain and spinal cord.
Cognitive The functions of the mind by which we become aware of all aspects of perceiving, thinking and remembering.
Coma The state of not being responsive or able to be aroused. Person does not open their eyes, follow commands or speak.
Concussion Disruption of brain function usually from a blunt impact to the head causing the brain to bounce inside the skull.
Contrecoup Bruising of the brain tissue on the side opposite to where the blow was struck.
Craniectomy Surgical removal of a section of the skull.
Craniotomy The making of a surgical opening through the skull, by removing a segment of bone, which is usually replaced. This allows access to the brain and its coverings.
CSF CSF or Cerebro-Spinal Fluid is liquid which fills the ventricles of the brain and surrounds the brain and spinal cord.
CT Scan Computerised Axial Tomography. Series of X-rays at all different levels of the brain.
Diffuse Brain Injury Injury to cells in many areas of the brain rather than in one specific location.
Disinhibition Unrestrained behavior resulting from a lessening or loss of inhibitions and lack of control over impulses due to frontal lobe trauma.
Dysarthria Speech impairment resulting from damage to the nerves and areas of the brain that control the muscles used in forming words.
Dysautonomia A malfunctioning of the autonomic nervous system, presenting primarily as ineffective temperature regulation and ineffective regulation of heart-rate and breathing.
Dysexecutive Syndrome Impaired executive abilities, usually resulting from damage to the frontal lobes. Executive abilities including attention and concentration, planning and initiation, problem solving and monitoring of goal-directed activities.
Dyskinesia An impaired ability to make voluntary movements, resulting in uncoordinated or involuntary movements.
Dysphagia Difficulty with swallowing.
Dysphasia Difficulty understanding or expressing language as a result of damage to the brain.
Dyspraxia Difficulty performing voluntary movements not due to weakness but because of motor coordinating problems.
Echolalia Imitation of sounds or words without comprehension. This is a normal stage of language development in infants but is abnormal in adults.
EEG EEG or Electroencephalogram is a test used to record any changes in the electrical activity of the brain by placing electrodes on the scalp. An EEG is used in the testing of epilepsy.
Electroencephalogram Electroencephalogram (EEG) is a test used to record any changes in the electrical activity of the brain by placing electrodes on the scalp. An EEG is used in the testing of epilepsy.
Embolism Blood clots are the clumps that result from coagulation of the blood (blood hardens from liquid to solid). A blood clot that forms in a blood vessel or within the heart and remains there is called a thrombus. A thrombus that travels to another location in the body is called an embolus. The disorder is called an embolism. For example, an embolus that occurs in the brain is called a cerebral embolism.
Embolus Blood clots are the clumps that result from coagulation of the blood (blood hardens from liquid to solid). A blood clot that forms in a blood vessel or within the heart and remains there is called a thrombus. A thrombus that travels to another location in the body is called an embolus. The disorder is called an embolism. For example, an embolus that occurs in the brain is called a cerebral embolism.
Emotional lability Repeated, rapid, abrupt shifts in emotion that are not related to external stimuli.
Epilepsy A seizure disorder: A chronic condition caused by temporary changes in the electrical function of the brain, causing seizures which affect awareness, movement or sensation.
Executive Function Range of abilities to plan, monitor oneself, learning from experience and accomplish steps to reach a goal. Often affected by frontal lobe injury.
Focal Brain Injury Injury restricted to one region (as opposed to diffuse).
Frontal Lobes The region of the brain directly behind the forehead. Responsible for planning, organising, problem solving, selective attention, personality and a variety of “higher cognitive functions”. Damage can cause changes to personality, dysexecutive syndrome, problems with spoken language and impaired social skills.
QCAT The Queensland Civil and Administrative Tribunal -QCAT is part of the Queensland Department of Justice and Attorney-General. It is an independent body, and one of its functions is to decide whether people have capacity to make decisions.
Glasgow Coma Scale Measures the degree of disturbed consciousness arising from trauma.
Haematoma A collection of blood in an organ, space or tissue, due to a break in the wall of a blood vessel.
Hard Collar Stiff plastic collar worn to support the neck.
Hemianopia Blindness in the same sides of both eyes which can follow damage to the brain. This can cause an inability to see on the left or right side.
Hemiparesis Weakness, partial paralysis or loss of movement that only affects one side of the body.
Hemiplegia Paralysis of one side of the body. May be associated with spasticity – increased muscle tension and spasms.
Heterotopic Ossification Abnormal deposits of bone in muscle.
Homeostasis The ability of the body to maintain a stable internal environment, e.g. temperature, breathing, blood-sugar levels. Mainly controlled by the Autonomic Nervous System through the hypothalamus.
Hydrocephalus Enlargement of the ventricles due to an increase of fluid (CSF) on the brain.
Hypertension Abnormally high blood pressure.
Hypotension Abnormally low blood pressure.
Hypothalamus Small region of the brain at the top of the brain stem which regulates the Autonomic Nervous System.
Hypoxia An insufficient supply of oxygen to cells of the body. May result in cell death if severe. Can be through not enough oxygen reaching the blood, e.g. due to drowning or carbon monoxide poisoning, or not enough blood reaching the cells, e.g. due to bleeding or constricted blood vessels such as a blood clot causing a stroke.
ICP Intracranial Pressure: A measure of the amount of pressure inside the skull from brain tissue, blood and cerebrospinal fluid. Increased pressure is a sign of intracranial hemorrhage or cerebral swelling that can lead to secondary brain injury.
Impulsivity A tendency to rush into something without thinking or reflecting first.
Intra-Cerebral Haematoma A blood clot in the brain that occurs due to trauma, also commonly resulting from a stroke.
Intracranial Pressure Monitor A monitoring device to determine the pressure within the brain. It consists of a small tube (catheter) in contact with the pulsating brain or the fluid cavity within it. ICP is measured by means of a metal screw or a plastic catheter connected to an electronic measuring device.
Magnetic Resonance Imaging (MRI) Enables detailed pictures of the brain to be acquired using a scanning machine. It uses a strong magnet rather than X-rays.
Migraine Severe headache often associated with sensitivity to light or noise. May emerge after acquiring a brain injury.
Minimally Responsive State (MRS) A state of consciousness following a coma in which the patient appears to be awake but is unable to respond to their environment and can only make reflex movements. Previously known as Persistent Vegetative State or PVS.
MRI MRI or Magnetic Resonance Imaging enables detailed pictures of the brain to be acquired using a scanning machine. It uses a strong magnet rather than X-rays.
MRS Minimally Responsive State. A state of consciousness following a coma in which the patient appears to be awake but is unable to respond to their environment and can only make reflex movements. Previously known as Persistent Vegetative State or PVS.
Neuropsychologist A psychologist with further studies in brain function, personality and behaviour.
Occipital Lobes Region in the back of the brain which processes visual information. Damage to this lobe can cause visual deficits.
Oedema Increased fluid content in the brain causing swelling.
Parietal Lobes Left and right lobes located in the middle and top of the brain. Responsible for visual attention and processing, spatial awareness, touch perception and manipulation, voluntary movements, and the integration of different senses. Damage can cause difficulty with identifying or naming objects, difficulty with writing or mathematics and difficulty with motor coordination or being aware of space and distance.
Peg Tube Short for “Percutaneous endoscopic gastrostomy” tube. A tube inserted into the stomach through the abdominal wall to provide food or other nutrients when eating by mouth is not possible. Commonly used for patients in a COMA or PERSISTENT VEGETATIVE STATE.
Perseveration The inappropriate persistence of a response in a current task which may have been appropriate for a former task. Perseverations may be verbal or motoric.
Persistent Vegetative State (PVS) A state in which the CEREBRAL CORTEX stops working. A person in a PVS may open their eyes but can not understand what is happening around them, communicate or make voluntary movements. See also Minimally Responsive State (MRS).
Post Traumatic Amnesia (PTA) The period after being in a coma when there is confused behaviour and no continuous memory of day-to-day events.
Premorbid Existing before the injury. This can refer to attitudes, interests, personality traits or medical conditions.
Proprioception The sensory awareness of the position of body parts with or without movement.
PTA Post Traumatic Amnesia: The period after concussion or being in a coma when there is confused behaviour and no continuous memory of day-to-day events.
PVS Persistent Vegetative State or PVS is a state in which the CEREBRAL CORTEX stops working. A person in a PVS may open their eyes but can not understand what is happening around them, communicate or make voluntary movements. See also Minimally Responsive State (MRS).
Seizure An uncontrolled discharge of nerve cells, usually lasting only a few minutes. It may be associated with loss of consciousness, loss of bowel and bladder control, and tremors.
Sequela Occurring as a result of an illness or injury e.g., a loss in short-term memory following a brain injury.
Shunt An apparatus designed to remove excessive fluid from the brain. A surgically placed tube which transfers fluid into either the abdominal cavity, heart or large veins of the neck.
Spasticity An involuntary increase in muscle tone (tension).
SPECT Single Photon Emission Computed Tomography. A diagnostic scan that uses a small, safe amount of a radioactive drug to measure blood flow inside the brain. Not as sensitive as a PET scan, but more useful for examining seizure activity.
Symptom Evidence of an illness or injury i.e., anything that the patient experiences as a result of that illness or injury.
Tachycardia Excessively rapid heartbeat. Usually refers to a heartbeat of greater than 100 beats per minute (BPM).
Temporal Lobes Two lobes, one on each side of the brain located at about the level of the ears. Responsible for interpreting and understanding sounds, categorisation of objects, some visual processing and short and long term memory. Damage can result in impaired memory, hearing and recognition of objects.
Thermoregulation The maintenance of a stable body temperature. Thermoregulation can be impaired through damage to the brain stem, particularly the
HYPOTHALAMUS.
Thrombus Blood clots are the clumps that result from coagulation of the blood (blood hardens from liquid to solid). A blood clot that forms in a blood vessel or within the heart and remains there is called a thrombus. A thrombus that travels to another location in the body is called an embolus. The disorder is called an embolism. For example, an embolus that occurs in the brain is called a cerebral embolism.
Tracheostomy This is a breathing tube inserted through the middle of the neck just below the voice box. Through this tube an adequate air passage can be maintained. It may be necessary to leave the tube in the windpipe for a prolonged period.
Ventilator This is a machine that does the breathing work for the unresponsive patient. It delivers moistened (humidified) air with the appropriate percentage of oxygen and at the appropriate rate and pressure.
Ventricles Cavities (spaces) inside the brain which contain cerebro-spinal fluid.

Reference: Acquired Brain Injury: The Facts (Synapse)

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