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GUIDELINES FOR COMPLETION OF AN APPLICATION
In accordance with the provisions of clause 6(6) of Schedule 3 of the Mental Health Act 1986,
the Board has issued the following guidelines to assist those persons who wish to apply to the
Board for consent to perform psychosurgery on a person.
Background
Section 58 of the Act provides that a psychiatrist who seeks to arrange for a neurosurgeon to
perform psychosurgery on the person must apply to the Board for its consent. It goes on set
out the matters which must be specified in the application, namely:
- the exact nature of the psychosurgery proposed, and the qualifications of the proposed
neurosurgeon/s;
- the clinical indications for the psychosurgery;
- the service, hospital or clinic in which the psychosurgery is to be performed;
- whether the person is capable of giving informed consent (in accordance with the
requirements of s53B of the Act); and
- whether the person has given informed consent (in accordance with the requirements of
s53B of the Act).
In order to facilitate the capacity of the Board to hear and determine applications in an efficient,
effective and timely manner, the Board has established the following guidelines of its general
requirements in relation to the content of the application and documentation provided to the
Board in support of the application.
1. |
The Board’s application form should be used. |
2. |
Applications should be forwarded to the Chairperson at the above address. |
3 |
The application form must be completed and signed by the psychiatrist who seeks to
arrange for a neurosurgeon to perform the proposed psychosurgery. |
4. |
When completing part C1, the extent to which physical disorder has been excluded must
be included, and results (including normal range for that laboratory) of any investigations
performed as part of that process attached.
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The following tests are likely to have been performed:
(a) Full blood count, including ESR.
(b) Electrolytes and creatinine.
(c) Skull and chest X-ray.
(d) EEG.
(e) Brain imaging.
(f) Thyroid function test.
(g) Liver function test.
(h) Parathyroid function test.
(i) Vitamin B12 and Folate.
(j) Syphilis serology.
(k) AIDS antibody testing.
5. |
When completing part C1, the extent to which psychological testing has been performed
and by whom and when must be included.
Such testing is likely to have included IQ, personality and neuropsychological testing, as
well as depression and anxiety ratings performed by persons skilled in the administration
and interpretation of such instruments.
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6. |
When completing part C2, details of the extent to which the following treatment procedures
have been used (chronology, dosage/s, combination/s, duration), the responsible clinician’s
name, the place of administration, and the response/s must be included:
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(a) |
All antidepressants (including SSRI, SNRI, MAOI, NARI, Tricyclic and Tetracyclics) |
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(b) |
Other prescribed medications, in particular, antipsychotics and mood stabilisers |
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(c) |
Clomipramine (in the case of patients with Obsessive-Compulsive Disorder) |
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(d) |
ECT (unilateral and bilateral) |
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(e) |
Psychotherapy, including Cognitive Behaviour Therapy and Interpersonal Therapy |
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(f) |
Repetitive Transcranial Magnetic Stimulation (rTMS) |
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(g) |
Other treatments |
| 7. |
In respect of compliance with clauses 5 and 6 above, at a minimum, the applicant must provide to the Board: |
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(1) |
Accurate and detailed chronological summaries of the clinical notes of all significant inpatient admissions relevant to the application, or, if feasible, the actual clinical notes. |
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(2) |
Detailed reports from all medical and allied health professionals who have provided significant treatment and care for the patient during periods relevant to the application that include (as a minimum): |
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(a) |
accurate and detailed chronological summaries of all pharmacological, psychiatric, psychological and other treatments provided to the patient |
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(b) |
detailed reports from all treating practitioners, including consultant psychiatrists, psychologists and other allied health professionals, including any mental state, treatment or other relevant assessments given and outlining their involvement in the patient’s treatment |
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(c) |
accurate and detailed chronological summaries of the clinical notes of all significant inpatient admissions relevant to the application |
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(d) |
detailed report/s from at least one of the leading clinicians addressing in respect of the patient an accurate and detailed chronological developmental history, and accurate and detailed chronological past psychiatric and co-morbid psychiatric histories |
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(e) |
detailed report/s from at least one of the leading clinicians addressing in respect of the patient an accurate and detailed chronological pharmacotherapy and treatment history relevant to the application, including names of medications and combinations of medications; dosages; dates and periods of use; changes and dates of changes; cessation and dates of cessation; symptom response and benefits and periods of symptom response and benefits; side-effects, and adverse effects and reactions, and periods of side-effects, and adverse effects and reactions; and clinical indications and reasons for decisions to change and/or cease medications. |
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(3) |
A detailed and comprehensive report and assessment from an independent psychiatrist considered a leading expert in the management of the psychiatric disorder/s relevant to the application who has personally examined the patient. |
| 8. |
In order to facilitate the efficient scheduling of hearings, and to reduce the likelihood of otherwise avoidable adjournments by the Board to obtain further information, by way of a non-binding preliminary procedure, the Board will refer the application and supporting material for review as to compliance with clauses 4-7 above. In the event that the Board forms a preliminary view that the application and supporting material fail to sufficiently comply with these guidelines, the applicant will be notified of the further material required before the application will be scheduled for a hearing. |
| 9. |
Notwithstanding the preliminary procedure, as an inquisitorial body, the Board may adjourn proceedings to obtain further information in the event that it considers that the information provided with the application and/or at the hearing is insufficient for it to make an informed decision on all issues. However, in practical terms, to a great extent the Board must rely on the information provided by the applicant with the application and is limited in its capacity to conduct a wider investigation. For this reason, it is in the interests of the applicant and patient to ensure that, consistent with these guidelines, all available material relevant to the application is made available to the Board at the time the application is lodged. Failure to do so may affect the determination made by the Board. |
| 10. |
As the Board is required to comply with the rules of natural justice, the person upon whom it is proposed to perform the psychosurgery will be provided with copies of the application and all supporting material, unless an application is made to the Board that the person be denied access to some or all of the material. Notice of an application to the Board for an order that the person upon whom it is proposed to perform the psychosurgery be denied access to the application form or any of the supporting material should be given at the time the application form is forwarded to the Chairperson. |
Contact
Applications and supporting documentation should be forwarded to the Chairperson at:
Psychosurgery Review Board
Level 30/570 Bourke Street
MELBOURNE VIC 3000
Applicants or other relevant persons should contact the Board’s executive officer or legal officer to
discuss any issues arising in relation to this guideline, or the preparation of an application for
supporting documentation.
John Lesser
Chairperson
29 May 2009
GUIDELINES FOR REPORTS ON THE PERFORMANCE OF PSYCHOSURGERY
In accordance with the provisions of clause 6(6) of Schedule 3 of the Mental Health Act 1986,
the Board has issued the following guidelines to assist those persons who are required by section
70(1) and section 70(1A) of the Mental Health Act 1986 (the Act) to report to the Board on the
performance of the psychosurgery and on its results.
Background
| 1. |
Section 70(1) of the Act provides that the neurosurgeon who performs psychosurgery on a person must make a written report to the Board on the performance of the operation within 3 months of the completion of the psychosurgery. |
| 2. |
Section 70(1A) of the Act provides that a psychiatrist who has arranged for a neurosurgeon to perform psychosurgery on a person must make a written report to the Board on the results of the operation – |
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(a) |
within three months after the completion of the psychosurgery; and |
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(b) |
after three months and within 12 months after the completion of the psychosurgery. |
| 3. |
Section 71 directs that the Board must undertake regular reviews of patients who have undergone psychosurgery. It would be most appropriate, if the Board is to properly review such persons, that the written reports coincide with the review process and that the reports form the basis for the review. The Board may determine in view of a report that permission should be obtained from the person on whom psychosurgery has been performed for a personal interview before the Board. |
Neurosurgeon’s Report
| 4. |
The neurosurgeon’s report, to be submitted within 3 months of the completion of the operation, should provide details of: |
- The operative procedure, including any operative or anaesthetic complications.
- The transfer from the neurosurgical ward to the psychiatric unit or hospital. Details of the post-operative period should include details of any complications, such as incontinence, confusion and epilepsy, their duration and any treatment which was instituted, and the response to treatment.
- Medications to be continued following transfer to a psychiatric unit or hospital should be detailed.
- Results of routine and other investigations performed in the post-operative period prior to transfer from the neurosurgical unit should be recorded. Although the Board is aware that it may be difficult to assess the results of the psychosurgery in terms of any amelioration of psychological distress or symptom shift, a brief psychological evaluation at the end of the post-operative period would be most useful.
- Following discharge from the neurosurgical unit, the surgeon should request a full psychological assessment of the results of the psychosurgery to the end of the third post-operative month, to assist the Board in the review process. This part of the report should include not only a detailed account of any progress during the period of three months post-operatively, but the results of any investigations, both psychological and organic, which are available, and details of treatment instituted or continued during this period.
Psychiatrist’s Reports
| 5. |
The Psychiatrist’s reports (to be submitted within three months and twelve months of performance of psychosurgery respectively) should provide detailed reports from all psychiatric, medical and allied health professionals who have provided significant treatment and care for the patient during the relevant post operative period that include (as a minimum): |
- Accurate and detailed chronological summaries of all pharmacological, psychiatric, psychosocial and other treatments provided to the patient in the post operative period
- Detailed reports from all treating practitioners, including consultant psychiatrists, psychologists and other allied health professionals, including any mental state, treatment or other relevant assessments given and outlining their involvement in the patient’s treatment
- Accurate and detailed chronological summaries of the clinical notes of all significant in-patient admissions (if any) in the post operative period
- Detailed report/s from at least one of the leading clinicians addressing in respect of the patient an accurate and detailed chronological pharmacotherapy and treatment history of the post operative period, including names of medications and combinations of medications; dosages; dates and periods of use; changes and dates of changes; cessation and dates of cessation; symptom response and benefits and periods of symptom response and benefits; side effects and adverse effects and reactions, and periods of side effects and adverse effects and reactions; and clinical indications and reasons for decisions to change and/or cease medications.
- Details of the patient’s psychosocial situation and supports (including living arrangements, carer/family situation, PDRSS interaction)
- Details of the patient’s functional levels (such as self-care, work, recreational, social, sporting and other activities)
- Assessment of positive and negative impacts (if any) of psychosurgery on the patient in terms of cognition, mood, treatment, lifestyle, functioning etc
- Assessment of likely developments and progress (include reasons)
Contact
6. Reports should be forwarded to the Chairperson at:
Psychosurgery Review Board
Level 30/570 Bourke Street
MELBOURNE VIC 3000
Applicants or other relevant persons should contact the Board’s executive officer or legal officer to discuss any issues arising in relation to this guideline, or the preparation of a report required by the Act.
John Lesser
Chairperson
29 May 2009
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