After the assaults on the Australian National University campus last year, the ACT Chief Psychiatrist, Dr Dinesh Arya, has made 35 recommendations to improve legislation, clinical care, and leave processes for people found not guilty due to mental impairment.
In response to these recommendations, the ACT Government will establish a cross-government taskforce, involving the Justice and Community Safety Directorate (JACS) and the ACT Health Directorate, to implement these recommendations with community advocates.
The ACT Government commissioned the review after Alex Ophel, found not guilty of attempted murder due to mental impairment (schizophrenia) six years before, allegedly attacked several people at the ANU in September.
Mr Ophel, an inmate at the Gawanggal Mental Health Unit, had been granted approved leave from the mental health facility. He allegedly stabbed two women students, hit a male student on the head with a frying pan, and punched another in the face. He was charged with attempted murder and other offences. In 2017, Mr Ophel had tried to kill his tutor and classmates with a baseball bat.
The ACT Government commissioned Dr Arya to review the circumstances surrounding the attacks. The Chief Psychiatrist’s investigation includes a clinical review, with a focus on the ANU incident; and an expanded review, focusing on care, treatment, and support provided to people deemed not guilty because of mental impairment, and who have been released from custody into the care of mental health services.
“There are some things that have been learned from this particular incident,” Emma Davidson, ACT Minister for Mental Health, said. “But it’s also given us an opportunity to look at what are the systemic changes that we need to prevent any future incident from occurring.”
All public service agencies (especially the public mental health services) provide high-quality care and support to people deemed not guilty because of mental impairment and who are released from custody into the care of mental health services, Dr Arya found.
However, the panel made what Ms Davidson described as “very technical” recommendations about how information flows between clinical mental health workers and the ACT Civil and Administrative Tribunal (ACAT) “around what we need to do to protect both community safety and a person’s therapeutic mental health journey to recovery”.
This includes orders around access to leave. “There might be some activities where it is really important that there is someone with the person while they are undertaking the activity,” Ms Davidson said. “There might be other times when it might be a very short period of time, maybe even only half an hour, where a person is undertaking leave, to work on something that builds their independence. That needs to be assessed on an individual, case-by-case basis. This is why advice from forensic mental health clinicians is so important to thinking through how leave orders work for an individual.”
The legislative review focused on the ACT’s handling of Conditional Release Orders (CROs) for individuals found not guilty due to mental impairment. The panel proposed clarifying conditions under CROs; empowering the ACT Civil and Administrative Tribunal (ACAT) to issue involuntary orders for treatment; requiring comprehensive forensic psychiatric reports for decision-making; updating legislation on considerations for imposing, varying, or revoking conditions; ensuring legal authority for apprehension in case of breaches; involving forensic mental health professionals in ACAT reviews; notifying and involving representatives for community safety and carers in hearings; and harmonising terminology and guidance across relevant acts for consistency.
The clinical recommendations include implementing best practice forensic assessment and treatment principles; conducting comprehensive forensic mental health assessments, risk assessments, and management plans for individuals; updating these documents regularly; and auditing them for timeliness and completion. Decision-making regarding the level of restriction imposed on individuals should consider their broader circumstances, including mental health, treatment compliance, insight, and risk of harm to others. Submissions to the ACAT by health services should provide comprehensive forensic mental health assessments, and a template for clinicians, along with an advisory note from the Chief Psychiatrist, should support this process.
The leave recommendations include clarifying legislation on detention and leave under a CRO; specifying conditions for leave revocation; and ensuring clarity on the authority to cancel leave. The leave panel within health services should have an independent chair with forensic mental health expertise, and include a member knowledgeable about community safety. Health services should provide reports to ACAT when deciding on leave; review policies for Missing Persons regarding inpatients; and develop a risk rating or flagging system for effective communication among police, ambulance, and health services. Formal procedures supporting carer involvement and participation should be integrated into leave processes.
