Resources for clinicians and delegates

Mental health act forms

Chapter

Section

Section name

Name of form

Form no.

3

19

Nominated person

Nominated Person - Appointment

15156

3

26

Entering into Advance Agreement

Advance Agreement

15299

3

27

Making Advance Consent Direction

Advance Consent Direction

15303

3

30

Effect of advance agreement and advance consent direction on guardian with authority to give consent for treatment, care or support

Consent to Mental Health Treatment, Care or Support by the Guardian

15211

4

33

Applications by people with mental disorder or mental illness-assessment order

ACAT Assessment Order Application Form

AF2016-30Z

4

34

Applications by other people-assessment order

ACAT Assessment Order Application Form

AF2016-30

4

35

Applications by referring officers-assessment order

ACAT Assessment Order Application Form

AF2016-30

5

51

Application for mental health orders

Application Form for Psychiatric Treatment Order, Community Care Order and/or Restriction Order

AF2016-28

5

62

Role of chief psychiatrist-PTO

PTO Treatment Plan and Location Determination

10348

5

64

Action if psychiatric treatment order no longer appropriate-no longer person in relation to whom ACAT could make order

Notice of revocation for PTO or RO

15161

5

64(1)(b)(i)

Action if Psychiatric Treatment Order no longer appropriate:

Written notice to the carer and/or Nominated person

15140

5

64(1)(b)(i)

Action if a Restriction Order in conjunction with a Psychiatric Treatment Order is no longer appropriate:

Written notice to the carer and/or Nominated person

15140

5

65

Powers in relation to a PTO

Seclusion

50010

5

65

Powers in relation to a PTO

Seclusion/Confinement Observations

60421

5

65

Powers in relation to a PTO

Mechanical, Physical Restraint, or Forcible Giving of Medication Form

35249

5

70(2)

Role of Care Coordinator-community care order

Community/Forensic Community Care Order-Care Plan-Care Coordinator's Determination

65463

5

70(3)

Role of Care Coordinator-community care order

Application for leave from a facility

15179

5

72(1)(b)(i)

Action if Community Care Order no longer appropriate:

Written notice to the carer and/or Nominated person

15140

5

72(1)(b)(i)

Action if a Restriction Order in conjunction with a Community Care Order is no longer appropriate:

Written notice to the carer and/or Nominated person

15140

5

72(4)

Action if CCO no longer appropriate

Application for Revocation

15162

5

72(4)

Action if CCO no longer appropriate

Notice of Intent to Revoke FPTO, CCO or FCCO

15160

5

73(5)

Powers in relation to CCO

Seclusion

50010

5

73(5)

Powers in relation to CCO

Seclusion/confinement observations

60421

5

73(5)

Powers in relation to CCO

Mechanical, Physical Restraint, or Forcible Giving of Medication Form

35249

5

77(2)b

Contravention of mental health order

Contravention of mental health order-written warning

15172

5

77(2)c

Contravention of mental health order

Notification of Contravention and Authorisation to Require a Person to be Detained

15165

5

78(4)

Contravention of mental health order-absconding from facility

Unauthorised leave from an inpatient facility-risk assessment

35257

5

78(4)

Contravention of mental health order-absconding from facility

Notification of return from unauthorised leave

10256

6

83

Statement of Action Taken

Statement of Action Taken-Apprehension by an Authorised Ambulance Office or Police Office

20264

6

83

Statement of Action Taken

Statement of Action Taken-Apprehension by a doctor or mental health officer

20263

6

84

Initial examination at approved mental health facility

Failure to conduct initial examination

15155

6

85

Authorisation of involuntary detention

Authorisation/Notification Involuntary Detention

20250

6

85(2)

Authorisation of involuntary detention

Application for a Further Period of Involuntary Detention - not exceeding 11 days

15151

6

88

Treatment during detention

Seclusion

50010

6

88

Treatment during detention

Seclusion/confinement observations

60421

6

88

Treatment during detention

Mechanical, Physical Restraint, or Forcible Giving of Medication Form

35249

6

91

Order for release

Release from Involuntary Detention

15166

7

94

Applications for forensic mental health orders -detainees etc

ACAT Application for a Forensic Mental Health Order

AF2016-32

7

103

Role of chief psychiatrist-forensic psychiatric treatment order

FPTO Treatment Plan and Location Determination

65464

7

103(2)a

Role of chief psychiatrist-forensic psychiatric treatment order

Leave whilst in detention-Forensic Mental Health orders

15177

7

105(4)

Action if forensic psychiatric treatment order no longer appropriate-no longer person to whom ACAT can make order

Application for Revocation

15162

7

105(1)(b)

Action if Forensic Psychiatric Treatment Order no longer appropriate

Written notice to the carer and/or Nominated person

15140

7

106(1)(b)

Action if Forensic Psychiatric Treatment Order no longer appropriate to detain person

Written notice to the carer and/or Nominated person

15140

7

106(4)

Action if forensic psychiatric treatment order no longer appropriate-no longer necessary to detain person

Application for Revocation

15162

7

107

Powers in relation to a FPTO

Seclusion

50010

7

107

Powers in relation to a FPTO

Seclusion/confinement observations

60421

7

107

Powers in relation to a FPTO

Mechanical, Physical Restraint, or Forcible Giving of Medication Form

35249

7

107(2)d

Powers in relation to a FPTO

Leave whilst in detention-Forensic Mental Health orders

15177

7

110(2)

Role of care coordinator-forensic community care order

Community/Forensic Community Care Order-Care Plan-Care Coordinator's Determination

65463

7

112(4)

Action if forensic community care order no longer appropriate- no longer person to whom ACAT could make order

Application for Revocation

15162

7

105(1)(b)

Action if Forensic Psychiatric Treatment Order no longer appropriate

Written notice to the carer and/or Nominated person

15140

7

106(1)(b)

Action if Forensic Psychiatric Treatment Order no longer appropriate to detain person

Written notice to the carer and/or Nominated person

15140

7

112(1)(b)

Action if Forensic Community Care Order is no longer appropriate

Written notice to the carer and/or Nominated person

15140

7

113(1)(b)

Action if Forensic Community Care Order no longer appropriate to detain person

Written notice to the carer and/or Nominated person

15140

7

113(4)

Action if forensic community care order no longer appropriate- no longer necessary to detain

Application for Revocation

15162

7

114

Powers in relation to FCCO

Seclusion

50010

7

114

Powers in relation to FCCO

Seclusion/confinement observations

60421

7

114

Powers in relation to FCCO

Mechanical, Physical Restraint, or Forcible Giving of Medication Form

35249

7

120 (1)a

Revocation of leave

Revocation of leave-forensic mental health orders

15176

7

120(6)

Revocation of leave granted by ACAT

FMHO-Notification of Detention

15150

7

121

Grant of leave for person detained by relevant official

Leave whilst in detention-Forensic Mental Health orders

15177

7

122

Leave in emergency or special circumstances

Leave in emergency or special circumstances-FMHO

15178

7

123(2)

Revocation of leave granted by relevant official

Revocation of leave-forensic mental health orders

15176

7

123(6)

Revocation of leave granted by relevant official

FMHO-Notification of Detention

15150

7

124(4)

Contravention of forensic mental health order

FMHO-Notification of Detention

15150

7

125(1)

Contravention of forensic mental health order

Wanted Person from a Secure Mental Health Facility

36500

7

125(4)

Contravention of forensic mental health order-absconding from facility

FMHO-Notification of Detention

15150

8

136

Transfer to mental health facility

Request to Transfer a Detainee from a Place of Detention or Correctional Centre to DMHU

36525

8

144A(3)

Transfer of custody if person admitted to secure mental health facility

Request to Transfer a Detainee from a Place of Detention or Correctional Centre to DMHU

36525

8

144A(5)

Transfer of custody if person admitted to secure mental health facility

Request to Transfer a Detainee from a Place of Detention or Correctional Centre to DMHU

36525

8

144A(7)

Transfer of custody if person admitted to secure mental health facility

Notification of Admission to DMHU

20269

8

144A

Transfer of custody if person admitted to secure mental health facility

Transfer to/from DMHU: Security and Escort Risk assessment

36526

8

144B

Taking person to appear before court

Transfer of custody between a place of detention or correctional centre and DMHU or DMHU and Court

20274

8

144C

Release etc on change of status of person

Notification of Action following release from court ordered custody

20272

8

144D

Power to apprehend if person escapes from secure mental health facility

Correctional Escapee from DMHU - Risk Assessment

36501

8

144E

Transfer to mental health facility

Transfer from AMC

15255

9

148

Administration of Electroconvulsive Therapy - Adult with decision-making capacity

Electroconvulsive Therapy Consent and Prescription form

15290

9

149

Administration of Electroconvulsive Therapy - Adult with decision-making capacity

Electroconvulsive Therapy Consent and Prescription form

15290

9

152

Administration of Electroconvulsive Therapy - Young person without decision-making capacity

Electroconvulsive Therapy Consent and Prescription form

15290

9

153

Application for electroconvulsive therapy order

ACAT Electroconvulsive Therapy (ECT)-Application Form

AF2016-33

9

165

Doctor must record electroconvulsive therapy

ECT Treatment Record

50005

Page last updated on: 6 Dec 2021