Emmanuel was brought to a Secure Extended Unit (SECU) four months ago. Since being in there, the treating team has been increasing Emmanuel’s medication. The treating team are concerned that the medications might create physical health issues for Emmanuel, so they want to keep him in the SECU to be monitored.
Emmanuel disagrees with the treating team about this medication increase and wants to be treated voluntarily in the community. Emmanuel decides that he needs to speak up.
Step 1 – Emmanuel identifies the issue
What is the issue(s) Emmanuel is concerned about?
Emmanuel has a number of disagreements with his treating team. He sits down and writes them out or records them on his phone:
- Emmanuel does not want to be on a treatment order and would like to be treated voluntarily
- Emmanuel would like to live in the community rather than the SECU
- Emmanuel believes that the treating team is not listening or responding to his concerns about treatment.
Who is the decision maker? Who can help Emmanuel?
Emmanuel learns that the problems about compulsory treatment at the SECU are decided by two decision-makers. The first is the senior psychiatrist, who is often called the 'consultant psychiatrist' (junior psychiatrists are often called 'registrar psychiatrists'). The second is the Mental Health Tribunal, which reviews decisions about whether someone needs compulsory treatment.
Step 2 – Emmanuel learns his rights
What are Emmanuel’s rights?
- make and participate in all decisions about his assessment, treatment and recovery
- be treated in a way that works towards his personal recovery and goals in life
- receive treatment in the least restrictive way possible
- appeal his compulsory treatment order.
What resources could help?
After reading , Emmanuel gathers information and makes a list of where he wants to live after he leaves hospital. Emmanuel also makes notes about how being in SECU impacts on him, and what opportunities there are for him outside SECU.
Emmanuel considers a mental health legal service to help appeal the treatment order. He also considers the Second Psychiatric Opinion Service to provide him an independent second opinion.
Step 3 – Emmanuel thinks about solution s
What is the main (preferred) solution?
Emmanuel discusses his options and solutions with someone he trusts. After that he decides that he wants to organise to meet with the psychiatrist to say he wants voluntary treatment in the community.
Are there alternative solutions?
Emmanuel may compromise by suggesting the following alternatives:
- longer periods of leave, such as overnight. This way he can prepare for leaving the hospital
- meeting with a private psychiatrist of Emmanuel’s choosing before he leaves SECU
- if it means that Emmanuel leaves sooner, he may consider bringing forward a meeting with the community case manager who looks after his care when he is out of SECU.
How will Emmanuel know whether he was successful or not?
Emmanuel defines success as being heard by the treating psychiatrist and developing a plan for his to leave the SECU and be treated voluntarily.
Step 4 – Emmanuel makes a plan
How will Emmanuel express his concerns?
Emmanuel prepares for the meeting by:
- having written notes on his views, preferences, rights and solutions
- having fact sheets ready, with important parts highlighted.
Emmanuel also prepares a list of questions for the psychiatrist in case they do not agree with his plan:
- How is the treating team's plan consistent with Emmanuel's rights under the Act?
- What are the treating team's concerns about him leaving or becoming voluntary?
- What are the specific steps that need to happen before Emmanuel leaves and becomes voluntary?
Who will Emmanuel express his concerns to, and when?
Emmanuel will talk to his current nurse (or a nurse he trusts) and ask to have a meeting with the psychiatrist. If there is no meeting already booked, Emmanuel will ask to have the meeting brought forward.
Who may support Emmanuel (if he wants support)?
Emmanuel may ask for a support person to attend the meeting with him, such as a family member, friend, nominated support person, or support worker he feels comfortable with.
Step 5 – Emmanuel enacts his plan
Emmanuel requests a meeting
Emmanuel requests a meeting with his psychiatrist and the meeting is scheduled within a week.
Emmanuel rehearses what he will say at the meeting before going along to the meeting, as well as collecting relevant documentation and information.
Emmanuel during the meeting
Emmanuel presents the following information:
- that he wants to leave SECU and have voluntary status, as well as the emotional impact of being held at SECU for compulsory treatment
- that he has decision-making rights, and that the service has responsibilities to respond to his views and preferences.
Where there was disagreement, Emmanuel asked the treating team the questions he had prepared under the "make a plan" section above.
Emmanuel makes an agreement with the psychiatrist
Emmanuel negotiates with his psychiatrist for a plan that involves him:
- becoming voluntary as he agrees to remain at the SECU for a further month whilst medication and physical health are monitored
- beginning a step by step process of expanding leave, beginning with full day leave and progressing to overnight leave over the next month, once new accommodation has been secured
- agreeing to engage with a social worker / occupational therapist to find places to live after he leaves SECU
- providing details of a private psychiatrist that he would prefer to work with after leaving. He begins working with both psychiatrists
- receiving a written plan from the treating team.
Step 6 – Emmanuel reviews the process
Emmanuel reflects – what happened, what worked, what didn’t work
Emmanuel reflects upon the outcome and is satisfied that he clearly communicated his preferences, that he successfully planned and spoke up, and was listened to during the review meeting.
Reviewed 25 August 2023