Mental health acts and out-of-hospital care: Legislative boundaries and the paramedic role in Australian mental health legislation

Abstract

Background: Changes to Australian mental health legislation have expanded the role of paramedics in managing mental illness. Paramedics in most Australian states and territories can now temporarily detain and transport people suspected of being mentally ill for further assessment if these people are viewed as being at risk or as posing a risk to others and as lacking capacity for decision making.

Aim: This paper examines current mental health legislation from the eight Australian states and territories. We explore the conditions for transport to involuntary care and additional powers granted to paramedics across jurisdictions to identify the differences and implications of legislation in this space.

Methods: Current Australian mental health legislation was examined for: how mental illness is defined; how capacity is defined; how the Acts refer to paramedics; and the powers granted to paramedics under each Act.

Results: All jurisdictions but Western Australia and Victoria have made legislative changes to authorise paramedics to initiate transport for assessment. Although Victoria has made legislative changes to authorise paramedics to initiate transport for assessment, a subsequent Amendment has paused the introduction of this change. The power to authorise paramedics lies with the head of ambulance services in some states and territories and with senior health officials, e.g., the Chief Psychiatrist in others. Paramedics are required to judge patient capacity and level of risk prior to transport.

Conclusion: Legislation has expanded the role of paramedics working with people with mental illness and guides how paramedics conceptualise, interpret and enact their powers in responding to patients with mental illness.

Fig 1. Key questions guiding the analysis of mental health legislation.