Draft Discussion Paper – People with Serious Mental Illness and Challenging Behaviours


The Chief Psychiatrist has been increasingly concerned about the standard of care being provided to people with serious, enduring mental illness and challenging behaviours. Both clinicians and families have expressed concerns about the current service system. They have identified gaps, fragmented services or parts of the service system that are not well structured to meet the needs of these individuals and their families.

As a consequence, the Chief Psychiatrist instigated a formal targeted review into the treatment and care of people who have serious mental illness with complex needs and challenging behaviour. He tasked the Research and Strategy team at the Office of the Chief Psychiatrist to undertake this review in partnership with key stakeholders, to develop options to enhance future clinical services for this cohort.

The Research and Strategy team have developed a discussion paper based on their investigations, and through small group and individual meetings with key mental health carer community managed organisations, peak consumer bodies and clinicians from a broad range of mental health services. This review is intended to be a catalyst for change.

Please consider and comment on the Draft Discussion Paper – People with Serious Mental Illness and Challenging Behaviours.

Written comments can be submitted via email by COB Friday 15 November 2019 to: Reception@ocp.wa.gov.au

Chief Psychiatrist Advisory: Options for people on CTOs who are in breach and/or need inpatient treatment

Queries about Community Treatment Orders (CTO) are among the most common reasons for mental health staff to contact the Chief Psychiatrist’s Clinical Helpdesk.

The OCP has put together a sheet summarising the CTO breach process, and also the three possible pathways for admitting someone on a CTO to inpatient care. It  includes some guidance on how to enter the legal journey on PSOLIS.

Chief Psychiatrist Advisory: Options for people on CTOs who are in breach and/or need inpatient treatment.

eLearning – Communicating Risks and Benefits

Australian Commission on Safety and Quality in Health Care

Helping patients make informed decisions: communicating risks and benefits

Health decisions often have no single ‘best choice’ and require choosing from multiple options. For patients (and carers) to understand risks and have the opportunity to actively be involved in sharing decisions, clinicians need to provide relevant and clear information about treatment options, and the potential benefits, risks, trade-offs and uncertainties of each. This information should reflect the best available evidence and take into account the patient’s personal opinions, preferences, values and priorities.

The Australian Commission on Safety and Quality in Health Care has developed a 2-hour e-learning module to support clinicians develop and refine their skills in communicating effectively about the benefits and risks of treatment options with patients. The module, Helping Patients Make Informed Decisions: Communicating benefits and risks, is available to all clinicians and practitioners.

RANZCP New Professional Practice Guidelines for the administering electroconvulsive therapy.

The Royal Australian New Zealand College of Psychiatrists (RANZCP) has recently published professional practice guidelines that provide practical guidance for psychiatrists prescribing and administering electroconvulsive therapy.

Electroconvulsive Therapy (ECT) is an effective treatment with a strong evidence base for a number of major depressive disorders and other psychiatric disorders. The purpose of the RANZCP guidelines is to encourage ECT practice that minimised adverse effects and improved outcomes for patients.

Please note that under the Mental Health Act 2014 ECT services and clinicians in Western Australia must have regard to the Chief Psychiatrist’s Guidelines for the use of Electroconvulsive Therapy in Western Australia when prescribing and administering ECT. The Chief Psychiatrist Guidelines for the Use of Electroconvulsive Therapy in WA  are currently being updated in line with evidence from research and best practice and ECT Guidelines from other Australian and international jurisdictions and professional bodies, including the RANZCP guidelines.

Seclusion and Restraint Data

The Chief Psychiatrist is committed to reducing the rate of restrictive practices, seclusion and restraint, in Western Australia (WA).  Nationally, WA has been a leader in reducing the rates of restrictive practices.  In order to promote transparency in the use of restrictive practices in WA, the Chief Psychiatrist has committed to publishing the rates of seclusion and restraint bi-annually for each authorised mental health service. 

The rates of seclusion and restraint for the first two quarters of the 2018-19 financial year can be found here:  WA Seclusion and Restraint Data.

Mental Health Complaint Handling Guidelines

The Health and Disability Services Complaints Office (HaDSCO) has now finalised and released the Guidelines for handling complaints about mental health services for service providers to use as a reference tool and develop complaint handling systems appropriate to the needs of their organisation.

The link to the Guidelines page on the HaDSCO website is: