see also:

• medico-legal issues in the ED

• ACEM paper - Forensic Testing and Examination in Emergency Departments (pdf)
• Forensic and Medical Sexual Assault Clinicians Australia (FAMSACA)

• Vic. Institute Forensic Medicine (VIFP)
  • DNA testing - paternity, body identification, pre-natal, immigration
  • toxicology testing or expert opinion services
  • donor tissue bank
  • expert opinion
  • forensic medicine courses

• CRIMES (MENTAL IMPAIRMENT AND UNFITNESS TO BE TRIED) ACT 1997 - defines the criteria for determining if a person is unfit to stand trial
• Vic. Crimes Act 1958
• Vic. Crimes Act (GROSS VIOLENCE OFFENCES) Amendments 2013
  • essentially adds a form of mandatory 4 year minimum non-parole sentencing for Gross Violent Crimes where serious injury results whether intentionally or recklessly in circumstances of gross violence (there are some special circumstances which may exclude this charge)
  • doctors may be requested to give evidence to help decide if serious injury resulted or if the injury could have been not from violence but from a fall or seizure
  • serious injury is defined in the Act as:
    • (a) an injury (including the cumulative effect of more than one injury) that
      • (i) endangers life; or
      • (ii) is substantial and protracted; or
    • (b) the destruction, other than in the course of a medical procedure, of the foetus of a pregnant woman, whether or not the woman suffers any other harm
  • injury occurring after 1st July 2013 means:
    • (a) physical injury; or
    • (b) harm to mental health
    • whether temporary or permanent
  • physical injury includes unconsciousness, disfigurement, substantial pain, infection with a disease and an impairment of bodily function
  • harm to mental health includes psychological harm but does not include an emotional reaction such as distress, grief, fear or anger unless it results in psychological harm
  • essentially, gross violence means that the offender either:
    • planned to cause, or a reasonable person would expect that the result would be, serious injury, or,
    • acted with another person, or,
    • planned to use, and did use an offensive weapon to cause serious injury, or,
    • continued to cause injury after the person was incapacitated, or,
    • caused serious injury while the person was incapacitated
  • if the circumstance of gross violence was not present, the offender could be charged with the alternate charge under sections 16, 17 or 18 of the Crimes Act 1958 which have not been amended and do not carry minimum sentencing
  • if the serious injury arose from negligence, then section 24 of the Crimes Act 1958 may apply.
  • if only a threat to inflict serious injury is made, the offender could be charged under Sect 21 of the Crimes Act 1958
  • lesser injuries or threats may fall under assaults in sections 31,39,etc of the Crimes Act 1958

• Forensicare is the trading name for the Victorian Institute of Forensic Mental Health and is funded by the Department of Health & Human Services and the Department of Justice.
• provides adult mental health services in Victoria for people involved in the criminal justice system
• services include:
  • a 116-bed secure hospital (Thomas Embling Hospital in Fairfield, Melbourne)
    • There are three patient types in Thomas Embling Hospital:
      • forensic patients found not guilty or unfit to be tried under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997
      • security patients (prisoners) who need compulsory mental health treatment under the Mental Health Act 2014
      • civil patients of area mental health services who cannot be managed in the community and who require compulsory treatment under the Mental Health Act 2014 in a secure environment.
  • comprehensive community-based programs
    • statewide service is located in Clifton Hill, close to Thomas Embling Hospital
    • primarily for people who have a serious mental illness and have offended, or are at high risk of offending
    • access the service via referral from area mental health services, Corrections Victoria, courts, the adult parole board, Thomas Embling Hospital, the acute assessment unit at Melbourne Assessment Prison, other government agencies and private practitioners
  • prison-based mental health service
    • provides specialist mental health services at some Victorian prisons
    • includes 24×7 services at the Melbourne Assessment Prison (MAP) for men and the Dame Phyllis Frost Centre for women

• the the community parts of the Mental Health ACT 2014 generally do NOT APPLY to prisoners, and as such, the usual Section 52 MH Treatment Orders do not apply, and thus they cannot be given medications against their will under a S52 - this creates major issues as those with chronic psychotic disorders may refuse anti-psychotic medications and become very unwell from a psychiatric view whilst in prison
• prisoners however, can be placed on a Section 276 mental health Secure Treatment Order within Part 11 of the Mental Health Act 2014 after assessment by a psychiatrist, and referred to a forensic psychiatric hospital (eg. Thomas Embling Hospital) as a “security patient” where they can be given medication and assessed by a psychiatrist, but there is often a wait for such beds and treatment is usually transient, and when they return to prison after being discharged from the Secure Treatment Order, they can then refuse medications again
• when prisoners are released from their custodial sentence, the forensic carers may deem them needing a MH assessment order, in which case, they are usually met on release by police and taken to the nearest ED on a Section 351 for a MH assessment - most of whom are then released into the community
• people brought to ED under arrest by the police and not on bail, also do not fit under the MH Act, and thus, if they have MH needs, they will need to be referred to a forensic medical officer, not the community mental health teams