Psychiatric assessment failure results in $130k payout

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Friday, 12 Jun 2026

This Supreme Court case highlights that hospitals must perform psychiatric assessments within statutory timeframes to determine whether a patient needs to be involuntary detained. While the legislation in this case has been superseded by the Mental Health Act 2015, the obligations remain similar, with implications for doctors, psychiatrists and psychiatric registrars working in emergency departments.

Patient attempts suicide

A man with a history of drug use, paranoid ideation and psychosis attempted suicide at his mother’s house. Police found him threatening to jump off a neighbour’s roof. After negotiating him down, police apprehended him under the Mental Health (Treatment and Care) Act 1994 (ACT) (the Act), in force at the time.

The patient arrived at the hospital around 4.30am and was treated for lacerations on his wrists. He was not restrained and observed by staff and his mother. Two requests were made of a psychiatric registrar to come and assess the patient, but due to other work requirements the assessment did not occur. The patient’s mother left the hospital to get some fresh clothes for the patient.

Around 1.15pm, the patient left the emergency department and jumped off a hospital building, fracturing both his legs. He was re-admitted and treated. Hospital notes said he jumped to escape a hallucination of shadows he believed were following him. It was not a suicide attempt.

Allegations against the hospital

Expert evidence was presented on behalf of the hospital in response to allegations they had failed to:

• properly monitor him
• prevent him from harming himself
• respond adequately to the knowledge he was delusional and prone to self-harm
• conduct enquiries in a timely manner to determine whether he presented a further risk of self-harm
• seek authorisation for involuntary detention in a timely manner.

The hospital’s expert believed the patient didn’t meet the criteria for involuntary detention under the Act,¹ as he was not actively suicidal and voluntarily agreed to treatment and assessment.

Evidence for the hospital, noted he had been receiving therapy for his psychotic delusions. His episode of self-harm also appeared impulsive and could not have been predicted from prior assessments. The hospital said it was in the “normal process” of assessing him when he absconded.

Hospital’s liability considered

The court decided whether the hospital was negligent based on a range of evidence from the hospital, witnesses, experts and medical notes.

The court noted that the hospital, as an approved health facility, had an obligation to detain the patient. Under the legislation, an assessment must be undertaken by a medical practitioner within 4 hours of the patient’s arrival to hospital.

“… it is clear that the purpose of this examination is to determine whether the involuntary detention of the plaintiff was to be authorised …” the court said.

The court found the 4-hour period had expired at 8.30am. By this time, no psychiatric assessment had been performed, and he became a voluntary patient.

On balance, the court preferred the patient’s expert’s evidence. The expert said that in circumstances where the patient was clearly psychotic and at significant risk of further self-harm, the hospital was obliged to continue his involuntary detention under the Act. The hospital also had a duty to closely monitor him in an area from which he could not abscond.

The court dismissed the hospital’s argument that a patient must actively refuse treatment and care, before an involuntary detention order can be made.

“If that were the case, a patient who simply declined to say anything to a medical practitioner conducting an examination under section 40, or was catatonic, could not be made subject to an involuntary detention order because they had not, in terms, refused treatment or care. This could not have been the intention of the legislature …” the court said.

Court findings

The court accepted that had a “properly conducted” mental health assessment occurred within 4 hours of the patient’s arrival, he would have been involuntary detained. He would not have absconded or been injured.

The court found the hospital failed to respond adequately to the knowledge the patient was delusional and prone to self-harm.

The hospital was found negligent for breaching its duty of care. It was ordered to pay the patient $130,440 in general damages, plus the costs of the proceedings.

Current legislative requirements

Under the current mental health legislation, a relevant doctor must examine a person detained at an approved mental health facility within 4 hours of the person being brought to the facility or being detained. A “relevant doctor” is defined as a doctor employed at the facility as a consultant psychiatrist, a psychiatric registrar in consultation with a consultant psychiatrist, or another doctor in consultation with a consultant psychiatrist.

This 4-hour window can be extended in limited circumstances. If no examination has occurred within 4 hours, but the person in charge of the facility believes on reasonable grounds that releasing the person would put their health or safety at substantial risk—or the person would seriously harm others or endanger public safety—they may continue to detain the person. If the person continues to be detained:

• the person in charge of the facility must immediately notify the chief psychiatrist that the person has been at the facility for 4 hours without an initial examination and
• the chief psychiatrist must arrange for an examination as soon as possible and within 2 hours of being told about the detention.

If the person has not been examined within this 6-hour window, the facility must release them. If the person was detained under the Crimes Act, they must be released into police custody.

The legislation also requires the person in charge of the facility to notify the public advocate in writing about any failure to conduct an initial examination within the required timeframes and the reasons for the failure.

Key lessons

Patients detained under mental health legislation should be treated in areas where they are closely monitored by hospital staff and can’t abscond. They should remain detained until a decision has been made about whether an involuntary treatment order should be extended or made.

• Hospitals must perform psychiatric assessments on patients detained under mental health legislation, within statutory timeframes. This ensures involuntary detention can be authorised in a timely manner if the patient poses a risk of harm to themselves or others.
• Courts expect hospital staff to heed a patient’s recent psychiatric history. A patient who appears to comply at the time must still be assessed based on recent psychotic or delusional behaviour.

¹The Act stated Where the doctor who examines a person under section 40 has reasonable grounds for believing that:

1. the person is mentally dysfunctional and, as a consequence, requires immediate treatment or care;
2. the person has refused to receive that treatment or care;
3. detention is necessary for the person’s own health or safety or for the protection of members of the public; and
4. adequate treatment or care cannot be provided in a less restrictive environment;

The doctor may authorise the involuntary detention and care of the person at an approved mental health facility for a period not exceeding 3 days.

This article was originally published in October 2023 and reviewed and updated in June 2026.